Approach to the Management of Thyroid Eye Disease

Abstract

Thyroid Eye Disease (TED), also known as Grave’s orbitopathy, is an autoimmune condition characterized by inflammation of the extraocular muscles, orbital fat and periocular tissues. As the most common orbital disease worldwide, its prevalence is estimated to be between 0.5–2% and it disproportionately affects females 4:1. Although the majority of TED cases occur in patients with Graves’ disease (80–90%), it can also be seen with patients with Hashimoto’s thyroiditis (10%), euthyroid individuals (5–10%) and thyroid cancer. At the time of initial Graves’ disease diagnosis, 25% of patients have clinically detectable orbital involvement that is often mild. The natural history of TED typically consists of an initial active inflammatory period lasting 6–36 months, which then plateaus and is followed by a quiescent fibrotic phase with stabilization of disease.