Successful reversion of vision loss in dysthyroid optic neuropathy (DON) by adjuvant diuretic therapy

Judit Kaluha; Agnes Dioszegi; Bernadett Ujhelyi; Sandor Barna; Edit Nagy; Emese Csiki; Eszter Berta; Nagy Endre V.; Miklos Bodor

doi:10.1530/endoabs.110.EP886

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Endocrine Abstracts (2025) 110 EP886 | DOI: 10.1530/endoabs.110.EP886

ECEESPE2025 ePoster Presentations Metabolism, Nutrition and Obesity (164 abstracts)

Successful reversion of vision loss in dysthyroid optic neuropathy (DON) by adjuvant diuretic therapy

Judit Kaluha ¹ , Ágnes Diószegi ¹ , Bernadett Ujhelyi ² , Sándor Barna ³ , Edit Nagy ⁴ , Emese Csiki ⁵ , Eszter Berta ¹ , Endre V. Nagy ¹ & Miklós Bodor ¹

Author affiliations

¹Division of Endocrinology, Department of Medicine, Debrecen, Hungary; ²Departments of Ophthalmology, Debrecen, Hungary; ³Nuclear Medicine, Debrecen, Hungary; ⁴Medical Imaging, Debrecen, Hungary; ⁵Oncology, Debrecen, Hungary

JOINT3611

Thyroid eye disease (TED) is the most frequent extrathyroideal complication of Graves’ disease. Severe, sight threatening TED poses a risk of complete vision loss and requires treatment with high dose intravenous methylprednisolone and, in the absence of an immediate response, urgent orbital decompression surgery.

Case Presentation: A 77-year-old female patient was presented at the Thyroid-Eye Clinic in Debrecen in May 2024 due to progressive vision deterioration and eyelid swelling. Upon examination, the visual acuity of the right and left eyes were 0.0 and 0.1 respectively. The diagnosis of TED was confirmed by elevated TRAb level (11.5 U/L), and by MRI and ^99mTc-diethylenetriamine pentaacetic acid (DTPA) SPECT/CT imaging. Clinical activity score (CAS) was 5 on the 7 item scale in both sides which, in combination with the high DTPA uptake, indicated active GO. Orbital MRI revealed optic nerve compression in both sides, with more severe apical crowding in the right side. According to our institutional protocol, in addition to standard of care including high-dose intravenous glucocorticoids and orbital irradiation, parenteral diuretic therapy was initiated, while the patient was closely monitored by the multidisciplinary team. During follow up, visual acuity of the left eye gradually improved from the initial 0.1 to 0.9, while vision did not return in the right eye. Proptosis by Hertel-score decreased from the initial 17 and 19 mm to 12 and 13 mm, right and left eye, respectively. This is the second report of a patient in whom the addition of intravenous diuretics to the standard glucocorticoid treatment facilitated the decrease in orbital pressure, and orbital decompression surgery could be avoided.