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Thyroid Eye Disease: A Comprehensive Review

  • Chapter
Orbital Inflammatory Diseases and Their Differential Diagnosis

Part of the book series: Essentials in Ophthalmology ((ESSENTIALS))

Abstract

Thyroid eye disease (TED) is a potentially vision-threatening autoimmune condition that is most commonly associated with Graves’ disease. The pathophysiology of TED is incompletely understood. The thyrotropin receptor and insulin-like growth factor-1 receptor are autoantigens that appear to play a central role in the aberrant activation of the orbital fibroblasts, which are the principal effector cells responsible for orbital soft tissue enlargement in TED. The most common clinical findings of TED include eyelid malposition, exophthalmos, and restrictive strabismus. Conservative measures such as ocular surface lubrication are the mainstay of treatment for mild TED. Euthyroidism should be rapidly achieved and maintained in all patients. Smoking is the most important modifiable risk factor for disease onset and progression. The current first line of therapy for active moderate-to-severe and vision-threatening TED is intravenous glucocorticoids. If the disease is refractory to intravenous glucocorticoids, then urgent surgical decompression is indicated. To treat compressive optic neuropathy, surgical decompression needs to relieve compression at the orbital apex. Orbital decompression surgery to reduce exophthalmos can involve orbital fat resection and removal of the lateral wall, medial wall, and, rarely, orbital floor. TED must be stable and nonprogressive for at least 6 months prior to surgical rehabilitation. TED rehabilitative surgery should be performed in the following sequence: orbital decompression, extraocular muscle surgery, and eyelid surgery. The efficacy of novel disease-modifying agents such as rituximab is under investigation.

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Shannon S. Joseph and Raymond S. Douglas declare that they have no conflict of interest.

No human or animal studies were carried out by the authors for this article.

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  1. Department of Ophthalmology, University of Michigan, 1000 Wall Street, Ann Arbor, MI, 48105, USA

    Shannon S. Joseph MD, MSc & Raymond S. Douglas MD, PhD

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Correspondence to Raymond S. Douglas MD, PhD .

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  1. Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, Ann Arbor, Michigan, USA

    Hakan Demirci

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Joseph, S.S., Douglas, R.S. (2015). Thyroid Eye Disease: A Comprehensive Review. In: Demirci, H. (eds) Orbital Inflammatory Diseases and Their Differential Diagnosis. Essentials in Ophthalmology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-46528-8_9

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