IMPORTANCE OF
CO-MANAGEMENT

Up to 50% of patients with Graves’ disease may develop TED. Because disease modalities differ, timely diagnosis and treatment are critical1

Prompt consultation with a TED Specialist is key to the successful co-management of Thyroid Eye Disease (TED)2,3

Image of a patient and their Thyroid Eye Disease specialist

Ask your patients these questions1,4

  • Do you have pain and/or pressure behind your eyes?
  • Have you experienced double or blurry vision?
  • Have you or your loved ones noticed changes in the appearance of your eyes?
  • Have you experienced dryness or grittiness of the eyes, even after using artificial tears or eye drops?

If your patient answers “YES” to any of the above, consult with a TED Specialist
who can perform a comprehensive TED baseline exam, including orbital imaging.3

If your patient has experienced ANY signs or symptoms below, consult with a TED Specialist so you can co-manage together3,5,6

SIGNS & SYMPTOMS

Icon of pressure or pain behind the eye Icon of pressure or pain behind the eye Icon of pressure or pain behind the eye

Orbital ache or pain

Icon of eyelid retraction, a common symptom of Thyroid Eye Disease Icon of eyelid retraction, a common symptom of Thyroid Eye Disease Icon of eyelid retraction, a common symptom of Thyroid Eye Disease

Eye bulging

Icon of diplopia, or double vision, represented by two overlapping pupils Icon of diplopia, or double vision, represented by two overlapping pupils Icon of diplopia, or double vision, represented by two overlapping pupils

Double vision

Icon of proptosis, a common symptom of Thyroid Eye Disease Icon of proptosis, a common symptom of Thyroid Eye Disease Icon of proptosis, a common symptom of Thyroid Eye Disease

Eyelid retraction

Icon of photophobia, also known as light sensitivity Icon of photophobia, also known as light sensitivity Icon of photophobia, also known as light sensitivity

Sensitivity to light

Icon of dry, gritty eyes caused by Thyroid Eye Disease Icon of dry, gritty eyes caused by Thyroid Eye Disease Icon of dry, gritty eyes caused by Thyroid Eye Disease

Dry or gritty eyes

Icon of swelling redness Icon of swelling redness Icon of swelling redness

Swelling or redness of eyelids or conjunctiva

restriction of eye movement icon restriction of eye movement icon restriction of eye movement icon

Restriction of eye movements

Icon of swelling of optic disc icon Icon of swelling of optic disc icon Icon of swelling of optic disc icon

Loss of color vision or swelling of the optic disc*

*Signifies possible optic nerve compression.

If you notice ANY of the above signs or symptoms, consult right away with a TED Specialist
who can perform a comprehensive TED baseline exam, including orbital imaging.3

DOWNLOAD A USEFUL CHECKLIST TO HELP IDENTIFY THE SIGNS AND SYMPTOMS OF TED, AND WHEN TO CONSULT WITH A TED SPECIALIST, HERE:

TED is a heterogenous condition, meaning symptoms may vary from patient to patient. TED manifestations are often misdiagnosed as allergies or conjunctivitis, especially when swelling and redness are present. Misdiagnoses of TED symptoms, such as changing and blurry vision and orbital aching and pain, can lead to significant delays in treatment. Patients with Graves’ disease are at a much higher risk for TED. Ask patients with Graves’ disease if they have any of these symptoms, as not all will be apparent. If so, consult with a TED Specialist to co-manage your patients together.1,5,7-10

Early consultation with a TED Specialist can benefit TED patients. A TED Specialist can help make a diagnosis by examining the eyes. For further confirmation, a CT scan or MRI of the eye muscles may be helpful. These scans can show swelling and enlargement in and around the orbit, which can be early signs of TED. There are other diagnostic tools available as well.1,3,11,12

The Clinical Activity Score (CAS) is one of several assessment scales designed to evaluate the signs and symptoms characteristic of TED. CAS is typically used in clinical trials and by payors.6 For more information on when to consult with a TED Specialist, please click here.

Signs and symptoms of TED may not always be visible, so it’s important to ask your patients if they are experiencing any new or worsening TED manifestations. If your patient has already been diagnosed with Graves’ disease, they may be at risk of developing TED.1,3,10

TED IS A COMPLEX DISEASE AND IS RECOMMENDED TO BE CO-MANAGED BY A MULTIDISCIPLINARY TEAM.2,3

Consult with a TED Specialist to co-manage your patients together. Locate a TED Specialist near you.

  1. Bahn RS. Graves’ ophthalmopathy. N Engl J Med. 2010;362(8):726-738. doi:10.2147/TCRM.S193018
  2. Ross DS, Burch HB, Cooper DS, et al. 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid. 2016;26(10):1343-1421. doi:10.1089/thy.2016.0229
  3. Barrio-Barrio J, Sabater AL, Bonet-Farriol E, Velázquez-Villoria Á, Galofré JC. Graves’ ophthalmopathy: VISA versus EUGOGO classification, assessment, and management. J Ophthalmol. 2015;2015:249125. doi:10.1155/2015/249125
  4. Verity DH, Rose GE. Acute thyroid eye disease (TED): principles of medical and surgical management. Eye (Lond). 2013;27(3):308-319. doi:10.1038/eye.2012.284
  5. Perros P, Neoh C, Dickinson J. Thyroid eye disease. BMJ. 2009;338:b560. doi:10.1136/bmj.b560
  6. Wiersinga WM, Perros P, Kahaly GJ, et al. Clinical assessment of patients with Graves’ orbitopathy: the European Group on Graves’ orbitopathy recommendations to generalists, specialists and clinical researchers. Eur J Endocrinol. 2006;155(3):387-389. doi:10.1530/eje.1.02230
  7. Wang Y, Patel A, Douglas RS. Thyroid eye disease: how a novel therapy may change the treatment paradigm. Ther Clin Risk Manag. 2019;15:1305-1318. doi:10.2147/TCRM.S193018
  8. Estcourt S, Hickey J, Perros P, Dayan C, Vaidya B. The patient experience of services for thyroid eye disease in the United Kingdom: results of a nationwide survey. Eur J Endocrinol. 2009;161(3):483-487. doi:10.1530/EJE-09-0383
  9. Konuk O, Anagnostis P. Diagnosis and differential diagnosis of Graves’ orbitopathy. In: Wiersinga WM, Kahaly GJ, eds. Graves’ orbitopathy: A Multidisciplinary Approach - Questions and Answers. 3rd ed. S Karger AG; 2017:74-92.
  10. Phelps PO, Williams K. Thyroid eye disease for the primary care physician. Dis Mon. 2014;60(6):292-298. doi:10.1016/j.disamonth.2014.03.010
  11. Dolman PJ. Grading severity and activity in thyroid eye disease. Ophthalmic Plast Reconstr Surg. 2018;34(4S Suppl 1):S34-S40. doi:10.1097/IOP.0000000000001150
  12. Kilicarslan R, Alkan A, Ilhan MM, Yetis H, Aralasmak A, Tasan E. Graves’ ophthalmopathy: the role of diffusion-weighted imaging in detecting involvement of extraocular muscles in early period of disease. Br J Radiol. 2015;88(1047):20140677. doi:10.1259/bjr.20140677
  13. Bothun ED, Scheurer RA, Harrison AR, Lee MS. Update on thyroid eye disease and management. Clin Ophthalmol. 2009;3:543-551. doi:10.2147/opth.s5228