Euthyroid graves' disease: Clinical characteristics, pathophysiological mechanisms, diagnostic challenges, and contemporary management approaches
Keywords:
Euthyroid Graves' disease, thyroid-associated ophthalmopathy, Graves' orbitopathy, thyroid-stimulating antibodies, thyrotropin receptor antibodies, orbital fibroblasts, autoimmune disease, orbital imagingAbstract
Background: Euthyroid Graves' disease (EGD) is an uncommon subtype of thyroid-associated ophthalmopathy characterized by orbital autoimmune inflammation occurring in the absence of clinical or biochemical thyroid dysfunction. Although it shares several immunopathological mechanisms with Graves' disease, EGD presents unique diagnostic and therapeutic challenges because ocular manifestations frequently precede thyroid abnormalities and conventional thyroid autoantibodies may be absent. Early recognition is therefore essential to prevent disease progression and preserve visual function. Aim: This review aimed to summarize the current evidence regarding the epidemiology, risk factors, pathogenesis, clinical characteristics, diagnosis, and management considerations of euthyroid Graves' disease. Methods: A comprehensive narrative review of published literature was conducted, focusing on clinical studies, systematic reviews, observational investigations, and experimental research evaluating the immunological mechanisms, diagnostic biomarkers, imaging characteristics, clinical manifestations, and long-term outcomes of patients with EGD. Results: Available evidence indicates that EGD accounts for approximately 0.9–15.4% of Graves' ophthalmopathy cases and generally presents with milder, asymmetric, or unilateral orbital involvement. Orbital fibroblast activation, T-cell-mediated inflammation, and TSH receptor autoimmunity are central pathogenic mechanisms. Thyroid-stimulating antibodies demonstrate greater diagnostic sensitivity than conventional antibody assays, while orbital CT and MRI provide valuable diagnostic confirmation.
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