Factitious hyperthyroidism
ICD-10 E05.4 · ICD-11 5A02.4

Treatment of Factitious Hyperthyroidism in Mild Thyroid Eye Disease (Thyroid Orbitopathy)

When factitious hyperthyroidism presents alongside mild thyroid eye disease (thyroid orbitopathy), clinical management must account for the orbital component. Systematically grading the severity of thyroid eye disease guides which therapeutic pathway is appropriate.

Clinical scenario This protocol is for patients with factitious hyperthyroidism who have concurrent mild thyroid eye disease (thyroid orbitopathy). Severity grading — distinguishing mild from moderate-to-severe and sight-threatening disease — is a key step in directing therapy for this presentation.
Approach (partial overview) Management in mild thyroid orbitopathy involves a defined course of targeted supplementation combined with local ocular surface measures. The complete regimen — including specific agents, duration, and the combined protocol — is set out in the structured evidence-based protocol below.
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References

The tool grades the severity of thyroid eye disease into 3 categories mild, moderate to severe, and sight threatening thyroid eye disease and is a useful tool for directing therapy.

A single course of supplementation of selenium (100 mcg twice daily) for 6 months may be given as it is likely to improve and prevent progression of thyroid eye disease.

Treatment with local artificial tears during the day and ophthalmic gels/ointments with a possible taping of the lids or using swimming goggles / eye masks at nighttime should be advised, to prevent or treat corneal exposure.

DOI: 10.1089/thy.2016.0229
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