What is ‘Quiet’ Thyroid Eye Disease?

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A subgroup of patients with thyroid eye disease (TED) have inactive disease (defined as clinical activity score <3) and present primarily with diplopia and proptosis, according to a study.

In this single-center retrospective review, the charts of 19 patients who had only had evidence of inactive TED were analyzed.

Before being referred to the researchers’ institution, 58% of patients had a previous diagnosis of Graves’ disease (GD). At the onset of TED, 80% (n = 15) were euthyroid. All patients had diplopia and 63% (n = 12) had proptosis. Asymmetric disease was found in 42% of cases.

Overall, the median clinical activity score on presentation was 1 (IQR 0-1).

During the follow-up, 85% (n = 16) of patients were classified as having moderate-to-severe TED. One patient required orbital decompression and 13 extraocular muscle surgery.

The authors concluded that further studies into patients with “quiet TED” may improve therapeutic choices.


Iñiguez-Ariza NM, Sharma A, Garrity JA, et al. The “Quiet TED”-A special subgroup of thyroid eye disease. Ophthalmic Plast Reconstr Surg. 2021;doi: 10.1097/IOP.0000000000001942. Epub ahead of print. PMID: 33782324.

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