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      Management of thyroid eye disease: a Consensus Statement by the American Thyroid Association and the European Thyroid Association

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          Abstract

          Thyroid eye disease (TED) remains challenging for clinicians to evaluate and manage. Novel therapies have recently emerged, and their specific roles are still being determined. Most patients with TED develop eye manifestations while being treated for hyperthyroidism and under the care of endocrinologists. Endocrinologists, therefore, have a key role in diagnosis, initial management, and selection of patients who require referral to specialist care. Given that the need for guidance to endocrinologists charged with meeting the needs of patients with TED transcends national borders, and to maximize an international exchange of knowledge and practices, the American Thyroid Association and European Thyroid Association joined forces to produce this Consensus Statement.

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          Most cited references162

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          2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis.

          Thyrotoxicosis has multiple etiologies, manifestations, and potential therapies. Appropriate treatment requires an accurate diagnosis and is influenced by coexisting medical conditions and patient preference. This document describes evidence-based clinical guidelines for the management of thyrotoxicosis that would be useful to generalist and subspecialty physicians and others providing care for patients with this condition.
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            Graves' Disease.

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              The 2016 European Thyroid Association/European Group on Graves' Orbitopathy Guidelines for the Management of Graves' Orbitopathy

              Graves' orbitopathy (GO) is the main extrathyroidal manifestation of Graves' disease, though severe forms are rare. Management of GO is often suboptimal, largely because available treatments do not target pathogenic mechanisms of the disease. Treatment should rely on a thorough assessment of the activity and severity of GO and its impact on the patient's quality of life. Local measures (artificial tears, ointments and dark glasses) and control of risk factors for progression (smoking and thyroid dysfunction) are recommended for all patients. In mild GO, a watchful strategy is usually sufficient, but a 6-month course of selenium supplementation is effective in improving mild manifestations and preventing progression to more severe forms. High-dose glucocorticoids (GCs), preferably via the intravenous route, are the first line of treatment for moderate-to-severe and active GO. The optimal cumulative dose appears to be 4.5-5 g of methylprednisolone, but higher doses (up to 8 g) can be used for more severe forms. Shared decision-making is recommended for selecting second-line treatments, including a second course of intravenous GCs, oral GCs combined with orbital radiotherapy or cyclosporine, rituximab or watchful waiting. Rehabilitative treatment (orbital decompression surgery, squint surgery or eyelid surgery) is needed in the majority of patients when GO has been conservatively managed and inactivated by immunosuppressive treatment.

                Author and article information

                Journal
                Eur Thyroid J
                Eur Thyroid J
                ETJ
                European Thyroid Journal
                Bioscientifica Ltd (Bristol )
                2235-0640
                2235-0802
                08 December 2022
                01 December 2022
                : 11
                : 6
                : e220189
                Affiliations
                [1 ]National Institute of Diabetes and Digestive and Kidney Diseases , National Institutes of Health, Bethesda, Maryland, USA
                [2 ]Department of Medicine , Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
                [3 ]Endocrinology Division , Department of Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
                [4 ]Department of Endocrinology , Leazes Wing, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
                [5 ]Department of Internal Medicine and Endocrinology , Medical University of Warsaw, Warsaw, Poland
                [6 ]Division of Endocrinology , Diabetes, and Metabolism, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
                [7 ]Department of Ophthalmology and Visual Sciences , University of British Columbia, Vancouver, Canada
                [8 ]Division of Endocrinology , Diabetes, and Metabolism, Department of Medicine, UCLA David Geffen School of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
                [9 ]Department of Ophthalmology , University Hospitals Leuven, Leuven, Belgium
                [10 ]Department of Clinical and Community Services , Graves’ Orbitopathy Center, Endocrinology, Fondazione IRCCS Cà Granda, Milan, Italy
                [11 ]Division of Endocrinology , Diabetes and Metabolism, Mayo Clinic, Rochester, Minnesota, USA
                Author notes
                Correspondence should be addressed to H B Burch: henry.burch@ 123456nih.gov

                *(H B Burch and P Perros were Task Force Co-Chairs)

                Article
                ETJ-22-0189
                10.1530/ETJ-22-0189
                9727317
                36479875
                49ab270e-66db-4fea-8c75-10f810410f00
                © American Thyroid Association and European Thyroid Association Published by Bioscientifica Ltd

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 19 October 2022
                : 19 October 2022
                Categories
                Consensus Statement

                thyroid eye disease,consensus statement,american thyroid association,european thyroid association

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