From the Guidelines
The workup for thyroid eye disease (TED) should include a comprehensive evaluation with orbital CT or MRI, thyroid function tests, and clinical activity scoring to determine disease activity and guide treatment planning. This approach is supported by the most recent and highest quality study, which emphasizes the importance of imaging studies, such as orbital CT or MRI, to evaluate extraocular muscle enlargement, orbital fat expansion, and optic nerve compression 1.
Key Components of the Workup
- A detailed medical history focusing on thyroid dysfunction and eye symptoms
- Physical examination, including assessment of visual acuity, color vision, pupillary responses, extraocular movements, exophthalmos measurement with an exophthalmometer, intraocular pressure, and eyelid retraction
- Laboratory testing, including thyroid function tests (TSH, free T3, free T4) and thyroid antibodies (TSI, TRAb, TPO)
- Imaging studies, such as orbital CT or MRI, to evaluate extraocular muscle enlargement, orbital fat expansion, and optic nerve compression
- Clinical activity scoring using the Clinical Activity Score (CAS) to determine disease activity
Additional Testing
- Visual field testing to assess for possible compressive optic neuropathy
- Corneal staining and tear production assessment to evaluate for dry eye
- Photography to document progression
- Binocular field testing to map the region of single binocular vision
- Ocular coherence tomography and Humphrey visual fields to provide ancillary information and monitor possible associated compressive optic neuropathy 1
Multidisciplinary Management
- Involving ophthalmologists and endocrinologists to ensure thyroid control and manage eye disease
- Early diagnosis and timely intervention to prevent vision-threatening complications
- Consideration of associated immune studies, such as antithyroid peroxidase antibody and antithyroglobulin antibody, to confirm the diagnosis and evaluate disease activity 1
From the Research
Diagnosis and Staging of Thyroid Eye Disease
- The diagnosis of thyroid eye disease is often straightforward, based on history and physical examination 2
- The severity of thyroid eye disease can be staged as mild, moderate-to-severe, and sight-threatening 2
- Eye-care practitioners play a crucial role in assessing functional vision and managing ocular health 2
Clinical Assessment and Management
- Advances in biomarkers and imaging are helping to tailor the management of patients with thyroid eye disease 3
- Emerging therapies are targeting different pathways in the disease, informed by studies into TED pathogenesis 3
- Developments in treatment options, such as therapies targeting the IGF1 receptor, have shown promise in reducing proptosis in thyroid eye disease 3