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

ATA/ETA · 2022 · Europe

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Authors: Henry B Burch, Petros Perros, Tomasz Bednarczuk et al.
Title: Management of thyroid eye disease: a Consensus Statement by the American Thyroid Association and the European Thyroid Association
Journal: European Thyroid Journal, 2022
DOI: 10.1530/ETJ-22-0189
Licence: CC BY 4.0
Changes: Verbatim excerpts; formatting adapted

Full text retrieved 2026-10-27 from Europe PMC · PMC9727317

Licence statement of the original publication

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

This page reproduces excerpts of the original publication; the original is authoritative. It has not been reviewed by a physician, does not state a recommendation of Medelix and does not replace medical advice. The guideline may have been updated since.

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Recommendations

Verbatim, with grade of recommendation or strength of consensus where given.

Safety

In the first RCT, the rate of all AEs was significantly higher with GC, occurring in 28% (22/79) compared with mycophenolate mofetil occurring in 5% (4/80) (106). The serious AE rate was 1.3% (1/79) for GC and 0% (0/80) for mycophenolate mofetil. In the second RCT, mild and moderate (grade 1–2) AEs also occurred in both groups including 47% (39/83) of patients treated with IVGC plus mycophenolate mofetil vs 36% (29/81) for those receiving GC alone, without statistically significant between-group differences. Serious AEs also occurred to a similar extent in both groups, including 16% (13/83) of patients receiving mycophenolate mofetil plus IVGC and 12% (10/81) of those given IVMP alone (68).

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.

Contents of the original publication

The section headings of the original.

1. Summary of Key Points
1.1. Diagnosis and assessment
1.2. Initial care and referral for specialty care
1.3. Therapy of moderate–severe TED
1.4. Therapy of sight-threatening TED
2. Introduction
2.1. Methods
3. Background
3.1. Epidemiology
3.2. Natural history
3.3. Pathogenesis
3.4. Risks for TED development and opportunities for prevention
3.5. Early diagnosis and referral for TED specialty care
3.6. Role of endocrinologists and ophthalmologists in the care of patients with TED
4. Patient assessment
4.1. Assessing disease activity and severity
4.2. Assessment of QOL
4.3. Formal ophthalmology evaluation
4.4. Imaging
5. Overall approach to therapy
5.1. Local and lifestyle measures
5.2. Overview of systemic medical and surgical treatments for TED
5.3. Setting for TED care
5.4. Referral to ophthalmology
6. Therapy for mild TED
6.1. Medical therapy for mild TED
6.2. Surgery for minimal changes in proptosis and lid retraction
7. Management of moderate-to-severe TED
7.1. Medical therapies
7.2. Radiotherapy for moderate-to-severe TED
7.3 Surgical intervention for inactive moderate-to-severe TED
8. Therapy for sight-threatening TED
8.1. Intravenous glucocorticoids
8.2. Radiotherapy in DON
8.3. Orbital decompression for DON
9. Overview of the management of TED
10. Research gaps in the management of TED
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