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Liyuan Liu Department of Endocrinology, Peking University First Hospital, Beijing, People’s Republic of China

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Yang Yu Department of Endocrinology, Peking University First Hospital, Beijing, People’s Republic of China

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Lei Chen Department of Ultrasound, Peking University First Hospital, Beijing, People’s Republic of China

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Yang Zhang Department of Endocrinology, Peking University First Hospital, Beijing, People’s Republic of China

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Guizhi Lu Department of Endocrinology, Peking University First Hospital, Beijing, People’s Republic of China

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Ying Gao Department of Endocrinology, Peking University First Hospital, Beijing, People’s Republic of China

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Junqing Zhang Department of Endocrinology, Peking University First Hospital, Beijing, People’s Republic of China

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, heterogeneous, and normal echogenicity ( 3 , 15 ). Hypoechogenicity was defined as an ultrasound signal significantly lower than normal thyroid tissue. Heterogeneous echogenicity is defined as the interweaving of low signal and normal tissue signal ( 3

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Ilaria Muller Department of Clinical Sciences and Community Health, University of Milan, Italy
Endocrinology Unit, Graves’ Orbitopathy Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

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Sara Maioli Department of Clinical Sciences and Community Health, University of Milan, Italy

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Mirco Armenti Department of Clinical Sciences and Community Health, University of Milan, Italy

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Laura Porcaro Department of Clinical Sciences and Community Health, University of Milan, Italy

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Nicola Currò Endocrinology Unit, Graves’ Orbitopathy Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
Ophthalmology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

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Elisabetta Iofrida Department of Specialistic Surgical Sciences, Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

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Lorenzo Pignataro Department of Clinical Sciences and Community Health, University of Milan, Italy
Department of Specialistic Surgical Sciences, Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

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Jacopo Manso Endocrinology Unit, Department of Medicine (DIMED), University of Padova, Padova, Italy

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Caterina Mian Endocrinology Unit, Department of Medicine (DIMED), University of Padova, Padova, Italy

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Jens Geginat Department of Clinical Sciences and Community Health, University of Milan, Italy
National Institute of Molecular Genetics (INGM) “Romeo and Enrica Invernizzi”, Milan, Italy

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Mario Salvi Endocrinology Unit, Graves’ Orbitopathy Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

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thyroid technetium-99m uptake, and thyroid ultrasound revealed typical features of GD; thus, she was put on methimazole therapy. One year after the onset of GD, she developed progressive moderate-to-severe active TED, and was treated with weekly IVGC

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