Managing TED in Practice: Expanding the Endocrinologist’s Scope On-demand-Thyroid Eye Disease

Video Transcription

Video Summary

This webinar, part of the ACE Rare Diseases and Hormone Disorders series, focused on thyroid eye disease (TED), a rare autoimmune condition often associated with Graves' disease. Experts Dr. Malini Gupta and Dr. Christian Nasser outlined TED’s epidemiology, pathophysiology, clinical presentation, diagnostic criteria, and management strategies. TED affects about 2 per 10,000 annually and may occur before, during, or after thyroid dysfunction. Risk factors include sex (more common in women), smoking, radioiodine treatment, and certain antibodies. Pathophysiology involves orbital fibroblast activation by thyroid stimulating immunoglobulins, causing muscle and fat expansion within the orbital cone, leading to symptoms such as eyelid retraction, proptosis, eye pain, and double vision. Disease activity is assessed by the clinical activity score (CAS), while severity ranges from mild to sight-threatening.<br /><br />Management varies by severity: mild cases focus on conservative measures like smoking cessation, selenium supplementation, and eye lubrication; moderate to severe cases may require systemic steroids, immunotherapy (notably FDA-approved teprotumumab), or surgery. The importance of multidisciplinary care involving endocrinologists and ophthalmologists was emphasized, with ongoing research into new treatments like batoclimab. Radioactive iodine is generally avoided due to risk of worsening TED. The webinar underscored the need for early diagnosis, risk factor modification, and tailored treatment to prevent complications and preserve vision.

Keywords

thyroid eye disease

TED

Graves' disease

autoimmune

clinical activity score

teprotumumab

orbital fibroblast activation

multidisciplinary care