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 25-50% of patients with Graves' disease.

''Pathophysiology''
autoimmune response against autoantigen, possibly the TSH receptor → retro-orbital inflammation
inflammation results in glycosaminoglycan and collagen deposition in the muscles

''Prevention''
    smoking - most important modifiable risk factor for thyroid eye disease
    radioiodine treatment may increase the inflammatory symptoms seen in thyroid eye disease (15%) - steroids may help avoid

''Features''
    patient may be eu-, hypo- or hyperthyroid at the time of presentation
    exophthalmos
    conjunctival oedema
    optic disc swelling
    ophthalmoplegia
    inability to close the eye lids may lead to sore, dry eyes. If severe and untreated patients can be at risk of exposure keratopathy

''Management''
    topical lubricants may be needed to help prevent corneal inflammation caused by exposure
    steroids
    radiotherapy
    surgery

''Monitoring patients with established thyroid eye disease'' - if Sx occur - urgent review by ophthalmologist
    unexplained deterioration in vision
    awareness of change in intensity or quality of colour vision in one or both eyes
    history of eye suddenly 'popping out' (globe subluxation)
    obvious corneal opacity
    cornea still visible when the eyelids are closed
    disc swelling