Endocrine Abstracts

Thyroid eye disease (TED) is an autoimmune inflammatory disorder that affects the orbital retrobulbar tissue, an extrathyroidal manifestation of Graves’ disease. Whilst most often associated with hyperthyroidism, TED may manifest in both euthyroid patients and those with a background of chronic autoimmune hypothyroidism, in up to 20% cases ⁽¹⁾ although data is lacking. This audit aimed to review the non-hyperthyroid cohort of patients presenting to a dedicated thyroid eye disease multidisciplinary clinic in a tertiary hospital.

Method: Retrospective Trust approved audit features of TED from MDT database (2016-2025) to include all non-hyperthyroid patients.

Results: 30/323 patients were non-hyperthyroid; 14 patients were biochemically euthyroid, and 16 patients were hypothyroid (overt/subclinical). 7 out of 25 documented patients were smokers. The average age was 50.7 (29-73 years) with female preponderance (73%). The most common ocular presentation was dry, gritty eyes (n:13/30 = 43.3%) and exophthalmos (n:18/30 = 60%), followed closely by ophthalmalgia and diplopia, with 2/3rd of group presenting with multiple symptoms. Though TED activity was mild (CAS score < 3) in more than half of patients (n:16/30 = 53%) ;12 patients (40%) had moderate-severe TED activity/severity and required systemic treatment with steroids/ immunosuppressants/ immunotherapy. Two patients needed orbital decompression, both of whom were noted to be smokers. TRAB was > 3 IU/l in 6 /12 patients with moderate-severe TED. Subsequent thyroid dysfunction occurred in 11 /14 euthyroid patients, with 9/14 becoming hypothyroid (81%) and none became hyperthyroid. Median time for subsequent thyroid dysfunction was 2 months to 5 years.

Conclusion: These findings challenge the perception that non-hyperthyroid patients have milder TED usually not warranting systemic treatment or surgery² and importance of recognition of TED in absence of hyperthyroidism. Subsequent thyroid dysfunction in those with euthyroidism and TED, emphasises the importance of advising patients to continue regular TFT monitoring.