Pathogenesis and Medical Management of Thyroid Eye Disease

Thyroid eye disease (TED) is caused by an inflammatory process involving the orbit and periorbital tissues in the setting of autoimmune thyroiditis. TED has been shown not only to impact visual and social functioning but also to reduce patients’ quality of life. Thyroid dysfunction in TED most frequently involves hyperthyroidism secondary to Graves’ disease (GD); hypothyroidism secondary to Hashimoto’s thyroiditis, or subclinical inflammation, are involved less commonly. Approximately 25–50% of patients with GD will develop clinically apparent TED some time during their lifetime. Sight-threatening disease is infrequent and occurs in approximately 3–5% of patients. In contrast, subclinical manifestations, including radiographic evidence of enlargement of extraocular muscles, may be present in a larger subset of patients.