This protocol addresses factitious hyperthyroidism occurring alongside moderate to severe thyroid eye disease that is currently active, characterised by a Clinical Activity Score (CAS) of 3 or above.
Thyroid eye disease severity is graded into three categories — mild, moderate to severe, and sight-threatening — each directing a distinct therapeutic approach. Active orbitopathy is defined by a CAS ≥ 3. Establishing both the severity category and the activity status is essential before selecting treatment.
For this scenario, interventional options directed at the orbits are available — including a targeted radiation-based approach for patients whose predominant feature is progressive diplopia, and surgical intervention for appropriate candidates performed by a suitably experienced operator.
DOI: 10.1089/thy.2016.0229
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.
Thyroid orbitopathy is considered active in patients with a CAS ≥ 3.
Radiotherapy is an option in patients whose principal feature is progressive diplopia but should be used with caution in diabetes to avoid possible retinopathy.
Surgery for moderate to severe eye disease should be performed by a surgeon experienced in these procedures and complications.
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