During a series of lectures on thyroid eye disease (TED) during the recently-concluded AAO 2020 Virtual conference, Steven M. Couch, MD, presented a to-do list for patients with newly-diagnosed thyroid eye disease. He should know. Dr Couch has been studying the disorder for years and most recently presented new data on the demographic and clinical characteristics of patients with TED. Along with his colleagues, the associate professor of ophthalmology and visual sciences at Washington University School of Medicine in St. Louis conducted a multi-institutional retrospective review to identify patients with TED who had superior isolated or predominant rectus/levator complex involvement. Among their findings at baseline:
After an average of 18 months of follow-up:
Dr Couch’s team concluded that “in the setting of abnormal TSI and/or thyrotropin receptor antibody, presence of upper eyelid retraction, and an otherwise unremarkable laboratory and systemic evaluation, a presumptive diagnosis of TED may be made, and the patient can be followed closely, as he/she is likely to develop involvement of other extraocular muscles, consistent with a more typical presentation of TED.”
Nahyoung Grace Lee, MD, assistant professor of ophthalmology at Harvard Medical School, addressed the audience on the topic of upper eyelid retraction. She acknowledged the challenge of achieving reliable results, particularly in individuals with TED. Performing best practices is key. Dr Lee drew largely from the key principles that were published earlier this year. They include:
Christina Choe, MD, a private practice oculoplastic surgeon in Hendersonville, NC, offered her expertise on TED masquerades. It has been noted that immunoglobulin G4 -related orbital disease can masquerade as TED, and vice versa. Indeed, the IgG4 subtype is common in TED. Individuals with the subtype and TED tend to be older, have more severe disease, and higher clinical activity scores. Clinicians are advised to be aware that the subtype plays an important role in the pathogenesis of TED.