Buku Medicine

Requesting TFTs

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Interpreting TFTs

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Erratic TSH levels

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Hyperthyroidism specifics

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Thyroid eye disease

Thyroid eye disease (TED) occurs with both Graves’ disease and Hashimoto’s thyroiditis – patients may be hyper/hypo/euthyroid at presentation.

  • More likely to occur in patients with very high TRAbs 
  • More likely in SMOKERS – smoking cessation is key aspect in Graves’ management to both prevent and help manage TED 

Common signs and symptoms – patients with Graves’ disease should be counselled to alert HCPs if these develop ASAP  - inform patient’s endocrinologist 

  • Grittiness, periorbital swelling, lid or conjunctival redness, watery eyes, retroorbital pain/pain on moving eyes, double vision  
  • NB not usually itchy or sticky unlike allergy/infection 

As well as concerns over appearance, TED carries a threat to sight in severe cases 

  • Mild TED is managed with lubricating eye drops, optimisation of thyroid function and selenium supplements (can get OTC) with endocrinology support.
  • Mod-severe TED should be managed in a specialist MDT thyroid eye clinic (ophthalmology and endocrinology). May require imaging, high dose steroids, surgery or other advanced therapies.
  • Indications for urgent (e.g. same day) referral include severe pain, blurry vision, loss of colour vision, corneal opacification, inability to close eyes. 


  • TEAMEd advice on thyroid eye disease - https://www.endocrinology.org/endocrinologist/125-autumn17/features/teamed-5-improving-outcomes-in-thyoid-eye-disease/