Thyroid eye disease (TED) is an inflammatory disease of the eye and the surrounding tissues. The inflammation is due to an autoimmune reaction - the body's immune system is attacking tissues within and around the eye socket. TED is sometimes referred to by other names, such as Graves' ophthalmopathy, Graves' orbitopathy, thyroid-associated ophthalmopathy, and/or thyroid orbitopathy.
TED, conversely, typically affects downward and nasal gaze. Inflammatory orbitopathy, such as granulomatosis with polyangitis (GPA, formerly known as Wegener's granulomatosis) – GPA typically presents with a mix of upper airway, lower airway, and renal pathologies. Patients may have conjunctivitis, episcleritis, scleritis, and/or uveitis.
TED is a self-limiting disease, with patients moving from the active to quiescent phase within 1-3 years with a 5-10% risk of recurrence [10]. Treatment for TED should start at the time of the diagnosis, as treatment becomes less effective as the disease progresses from the early, acute, active phase to the chronic quiescent phase.
The thyroid state of a patient presenting with TED is quite variable: 90% hyperthyroid, 6% euthyroid, 3% with Hashimoto's thyroiditis, and 1% hypothyroid [2]. Patients are simultaneously diagnosed with TED and thyroid dysfunction 20% of the time, and 60% present within 1 year of onset of thyroid disease [9]. However, TED can present long before (up to 10 years) or long after (up to 20 years ...
