Sustained 177Lu-FAPI-2286 Retention in Graves’ Orbitopathy

A 39-year-old man suffering from Graves’ ophthalmopathy, which was resistant to steroids (with a clinical activity score of 5/7 and a moderate-severe EUGOGO grade), had a 68Ga-FAPI-46 PET/CT scan. This scan showed strong bilateral FAPI activity in the extraocular muscles, especially in the inferior recti, even though his visual acuity remained normal. A later low-dose 177Lu-FAPI-2286 retention study confirmed that the radiotracer stayed selectively within the recti. This example suggests that fibroblast activation protein-targeted theranostics could be a new way to image and possibly treat Graves’ orbitopathy.