Grade* | Lid retraction | Soft tissues | Proptosis¶ | Diplopia | Corneal exposure | Optic nerve status |
Mild | <2 mm | Mild involvement | <3 mm | Transient or absent | Absent | Normal |
Moderate | ≥2 mm | Moderate involvement | ≥3 mm | Inconstant | Mild | Normal |
Severe | ≥2 mm | Severe involvement | ≥3 mm | Constant | Mild | Normal |
Sight threatening | – | – | – | – | Severe | Compression |
Upper limits of normal | ||||||
Black populations | F/M = 23/24 mm | |||||
White populations | F/M = 19/21 mm | |||||
Asian populations | F/M = 16/17 mm (Thai) or 18/19 mm (Chinese) |
F: female; M: male; TED: thyroid eye disease.
* Mild TED: patients whose features of TED have only a minor impact on daily life, generally insufficient to justify immunosuppressive or surgical treatment. Moderate-to-severe TED: patients without sight-threatening TED whose eye disease has sufficient impact on daily life to justify the risks of immunosuppression (if active) or surgical intervention (if inactive). Sight-threatening TED: patients with dysthyroid optic neuropathy and/or corneal breakdown. This category warrants immediate intervention.
¶ Proptosis refers to the variation compared with the upper limit of normal for each race/sex or the patient's baseline, if available.Reproduced with permission from: Ross DS, Burch HB, Cooper DS, et al. 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid 2016; 26:1343. Copyright © 2016 Mary Ann Liebert, Inc. publishers.
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