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Thyroid eye disease

Checked: 23-08-2020 by Vicky Ryan Next Review: 23-08-2022

Overview

These guidelines have been provided by the Endocrinology Team at NBT so pathways might be slightly different at UHBW

Definition

An autoimmune condition affecting the eyes that is associated with Graves’ disease

Important points

Can be mild, moderate or severe and occurs in approximately 25% of patients with Graves’ disease
It may be diagnosed before, after or at the time of diagnosis of Graves’ disease
It is almost 5 times more common in women than men, but is often more severe in men. It is seven times more likely to occur in smokers
Symptoms include – itching, watering, dry eyes, eyelid retraction, proptosis, corneal injection, double vision and decreased colour vision (severe cases)

Who to refer

For mild symptoms e.g. itching, grittiness, watering – give smoking cessation advice and prescribe topical lubricants. Advise the patients to consider buying selenium tablets (100 micrograms twice daily) which can be bought in health food shops.

Advise the patient to re-present if any deterioration in symptoms or not improving

For moderate – severe symptoms – refer urgently directly to the thyroid eye clinic at the Bristol Eye Hospital via eRS

Before referral

Further investigation

If not known to have existing Graves, take urgent TFTs (TSH, free T4, free T3), TPO and TSH receptor antibodies and manage as per hyperthyroidism
Ensure the patient has up to date TFTs if they are already known to have Graves’ disease, and ensure their thyroid disease is well managed
Smoking cessation advice

Services

Endocrinology NBT

Endocrinology UHBW

Resources

References:

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

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