Thyroid eye disease: How activity and severity should shape your treatment approach

Thyroid eye disease (TED) is more common than many realize, yet both patients and physicians are frequently misinformed about it. At OSN New York, Dr. Andrew Harrison urged ophthalmologists to recognize hallmark signs — lid retraction, proptosis, diplopia, and anterior segment inflammation — and to refer patients early to TED specialists for timely, appropriate care.

Central to treatment planning is distinguishing disease activity (degree of inflammation, graded via the 7-item Clinical Activity Score) from severity (impact on daily life, eyelid retraction, soft tissue involvement). TED follows a short active phase before transitioning to a chronic phase, making early intervention critical for medical therapies to work.

Key Takeaways:

• Smoking cessation, thyroid optimization, and ocular surface treatment are first-line for all TED patients
• Moderate-to-severe disease may warrant IGF-1R inhibitors (teprotumumab/Tepezza or veligrotug/Lumvoa) or IV glucocorticoids — both requiring careful monitoring
• Sight-threatening disease typically calls for high-dose steroids followed by orbital decompression surgery
• A CAS score of ≥4 out of 7 criteria indicates active disease

Why it matters: With a growing arsenal of targeted therapies, TED management is becoming increasingly personalized — but only if clinicians correctly stage the disease first. Early referral and accurate assessment can prevent irreversible vision loss and improve quality of life for patients.