Thyroid eye disease

What it is

Thyroid eye disease (thyroid-associated orbitopathy) is autoimmune orbital disease. TRAb act mainly on TSH receptors on orbital fibroblasts; there is cross-talk with IGF-1 receptors, expanding glycosaminoglycan, fat and extraocular muscle. The mechanism is still under study — it is not that one antibody always directly activates both receptors together. Hence proptosis, limited motility, diplopia and, when severe, apical crowding. Endocrinology and ophthalmology share care. This page is education, not self-diagnosis or a prescription.

Most cases associate with Graves hyperthyroidism; some with Hashimoto thyroiditis; some are euthyroid on blood tests. Controlling thyroid status is necessary but not sufficient — orbital activity can continue after thyroid treatment.

Common symptoms

• Redness, tearing, photophobia, incomplete lid closure or lid retraction
• Diplopia, noticeable proptosis; puffier lids in the morning
• Restricted movement and exposed dry ocular surface

Active vs inactive disease (education — not a home scorecard)

Specialists judge whether inflammation is still active. Active disease may lead to discussion of immunosuppression; inactive disease is when staged rehabilitative surgery is more often considered. Clinical activity scores (e.g. CAS) are clinic language — this page is not a DIY EUGOGO checklist.

Treatment ladder a specialist may discuss (classes, not your prescription)

1. Supportive care: lubrication and surface protection, head elevation; stopping smoking (including second-hand smoke) is among the most important modifiable factors. For some diplopia, a specialist or orthoptist may prescribe prism (e.g. temporary film) to ease double vision looking straight ahead. Do not buy prism stickers yourself or treat them as a substitute for examination.
2. Mild, recently active cases: a doctor may discuss selenium according to regional selenium nutrition and tests. European evidence is stronger for selenium-deficient regions; whether it suits Hong Kong and for how long is always a specialty decision. This page has no public dose table and does not mean moderate–severe disease should self-buy selenium.
3. Moderate–severe active disease: intravenous corticosteroids and steroid-sparing agents (e.g. mycophenolate class) arranged and monitored by specialists
4. Where registered and appropriate, specialists may discuss IGF-1R monoclonal antibody class or IL-6 receptor inhibitor class options; hearing, hyperglycaemia and infection risks are explained in clinic. Product names are not listed; trial scoreboards are not copied here

Inactive rehabilitative surgery sequence (education, not a booking menu)

When inflammation is largely quiet and surgery is still needed, education usually follows a strict order: orbital decompression → strabismus surgery → eyelid surgery — because each step changes the next. See the strabismus-surgery page. Whether and when to operate is decided in person; this site does not book appointments.

• Smoking cessation throughout
• No biologic product names on this page
• Endocrine–ophthalmology coordination; no clinic phone numbers or referrals here