Management of TED is ideally performed using a multidisciplinary team, each with an area of expertise. The endocrinologist manages the thyroid status, the ophthalmologist the orbital disease, a rheumatologist prescribes immunomodulators, the radiation oncologist plans radiotherapy, and a general surgeon may perform thyroidectomies.
Patients with TED are often frustrated by late diagnosis because of their mild, non-specific exposure complaints such as tearing, irritation, and light sensitivity. More serious manifestations of the disease such as myopathy and visual impairment generally develop rapidly and are more readily recognized.
Understanding what bothers the patient most about their condition helps to build rapport and to plan future management.
The patient and their family should be taught the natural history of the disease, the role of the immune system, and how management varies depending on the disease phase. Young patients with fat-targeted indolent disease can be reassured they are unlikely to develop serious complications, whereas high-risk individuals with rapid onset of more muscle-targeted disease should be advised about potential complications and that it may take up to 2 years until the disease is quiescent and restorative surgery performed.
Emphasize that they can take positive steps to help their condition by quitting smoking and relieving stressors in their lives. Various agencies can help with guidance or medications for smoking cessation. Local and web-based TED support groups may help. Emphasize the importance of maintaining a euthyroid status.
Supportive measures include cool compresses, head elevation for periocular congestion, and lubricants for exposure.
Specific medical, radiation and surgical therapies are described in the next sections followed by an overall management paradigm for specific manifestations of the disease using the VISA classification.