Expert Workgroup of Consensus on Standardized Procedures for Neuro-ophthalmologists in Evaluating Thyroid Eye Disease and Multidisciplinary Collaborative Management
,
Neuro-Ophthalmology Group of Ophthalmology Branch of Chinese Medical Association
,
Neuro-Ophthalmology Society of Chinese Research Hospital Association
Expert Workgroup of Consensus on Standardized Procedures for Neuro-ophthalmologists in Evaluating Thyroid Eye Disease and Multidisciplinary Collaborative Management,
Email: weishihui706@hotmail.com;
Neuro-Ophthalmology Group of Ophthalmology Branch of Chinese Medical Association,
Email: wusongdi@gmail.com
Thyroid eye disease (TED) is a complex, organ-specific autoimmune disorder closely related to thyroid diseases and one of the common orbital diseases in adults. The disease follows a characteristic “biphasic” course (active and inactive phases), with a broad spectrum of clinical manifestations ranging from mild eyelid retraction and lag to vision-threatening optic neuropathy and severe exposure keratopathy, imposing a significant physical and psychological burden on patients' quality of life as well as their physical and mental health. In current neuro-ophthalmology practice, the lack of a standardized and uniform assessment protocol leads to considerable variability in TED management strategies across different regions and clinicians. Furthermore, the complex nature of TED necessitates management beyond the scope of a single specialty, highlighting an urgent need for multidisciplinary collaboration. This consensus aims to establish and promote a standardized TED assessment system led by neuro-ophthalmologists. It emphasizes standardization, precision, and clinical operability, while advocating for a routine, institutionalized, and patient-centered multidisciplinary model to optimize clinical decisions and ultimately improve patient outcomes.
Citation： Expert Workgroup of Consensus on Standardized Procedures for Neuro-ophthalmologists in Evaluating Thyroid Eye Disease and Multidisciplinary Collaborative Management, Neuro-Ophthalmology Group of Ophthalmology Branch of Chinese Medical Association, Neuro-Ophthalmology Society of Chinese Research Hospital Association. Expert consensus on standardized procedures for neuro-ophthalmologists in evaluating thyroid eye disease and multidisciplinary collaborative management. Chinese Journal of Ocular Fundus Diseases, 2026, 42(2): 107-118. doi: 10.3760/cma.j.cn511434-20251111-00499 Copy
Copyright ? the editorial department of Chinese Journal of Ocular Fundus Diseases of West China Medical Publisher. All rights reserved
| 1. | Burch HB, Perros P, Bednarcauk T, et al. Management of thyroid eye disease: a consensus statement by the American Thyroid Association and the European Thyroid Association[J]. Thyroid, 2022, 32(12): 1439-1470. DOI: 10.1530/ETJ-22-0189. |
| 2. | Moledina M, Damato EM, Lee V. The changing landscape of thyroid eye disease: current clinical advances and future outlook[J]. Eye (Lond), 2024, 38(8): 1425-1437. DOI: 10.1038/s41433-024-02967-9. |
| 3. | Wiersinga WM, Eckstein AK, ?arkovi? M. Thyroid eye disease (Graves' orbitopathy): clinical presentation, epidemiology, pathogenesis, and management[J]. Lancet Diabetes Endocrinol, 2025, 13(7): 600-614. DOI: 10.1016/S2213-8587(25)00066-X. |
| 4. | Yu CY, Ford RL, Wester ST, et al. Update on thyroid eye disease: regional variations in prevalence, diagnosis, and management[J]. Indian J Ophthalmol, 2022, 70(7): 2335-2345. DOI: 10.4103/ijo.IJO_3217_21. |
| 5. | Wagner LH, Bradley EA, Tooley AA, et al. Thyroid eye disease or Graves' orbitopathy: what name to use, and why it matters[J/OL]. Front Endocrinol (Lausanne), 2022, 13: 1083886[2020-11-28]. https://pubmed.ncbi.nlm.nih.gov/36518254/. DOI: 10.3389/fendo.2022.1083886. |
| 6. | Ing EB, Madjedi K, Hurwitz JJ, et al. Nomenclature: thyroid-associated orbitopathy, Graves ophthalmopathy, or thyroid eye disease?[J/OL]. Can J Ophthalmol, 2021, 56(1): e22-e24[2020-07-20]. https://linkinghub.elsevier.com/retrieve/pii/S0008-4182(20)30624-4. DOI: 10.1016/j.jcjo.2020.06.004. |
| 7. | Rundle FF, Wilson CW. Development and course of exophthalmos and ophthalmoplegia in Graves' disease with special reference to the effect of thyroidectomy[J]. Clin Sci, 1945, 5(3-4): 177-194. |
| 8. | Bartley GB. Rundle and his curve[J]. Arch Ophthalmol, 2011, 129(3): 356-358. DOI: 10.1001/archophthalmol. |
| 9. | Bartalena L, Piantanida E, Gallo D, et al. Epidemiology, natural history, risk factors, and prevention of Graves' orbitopathy[J/OL]. Front Endocrinol (Lausanne), 2020, 11: 615993[2020-11-30]. https://pubmed.ncbi.nlm.nih.gov/33329408/. DOI: 10.3389/fendo.2020.615993. |
| 10. | Hegediüs L, Brix TH, Vestergaard P. Relationship between cigarette smoking and Graves' ophthalmopathy[J]. J Endocrinol Invest, 2004, 27(3): 265-271. DOI: 10.1007/BF03345276. |
| 11. | Xing L, Ye L, Zhu W, et al. Smoking was associated with poor response to intravenous steroids therapy in Graves' ophthalmopathy[J]. Br J Ophthalmol, 2015, 99(12): 1686-1691. DOI: 10.1136/bjophthalmol-2014-306463. |
| 12. | Cardo C, Bernardo Santos R, Pinotti Pedro Miklos AB, et al. The relationship between cholesterol levels and thyroid eye disease[J/OL]. Eur Thyroid J, 2025, 14(1): e240133[2025-02-03]. https://pubmed.ncbi.nlm.nih.gov/39819487/. DOI: 10.1530/ETJ-24-0133. |
| 13. | Liu J, Zhu T, Yang L, et al. Cigarette smoking drives thyroid eye disease progression via RAGE signaling activation[J]. Thyroid, 2025, 35(7): 803-815. DOI: 0.1089/thy.2025.0062. |
| 14. | Lanzolla G, Vannucchi G, Ionni I, et al. Cholesterol serum levels and use of statins in Graves' orbitopathy: a new starting point for the therapy[J/OL]. Front Endocrinol (Lausanne), 2020, 10: 933[2020-01-22]. https://pubmed.ncbi.nlm.nih.gov/32038490/. DOI: 10.3389/fendo.2019.00933. |
| 15. | Sabini E, Mazzi B, Profilo MA, et al. High serum cholesterol is a novel risk factor for Graves' orbitopathy: results of a cross-sectional study[J]. Thyroid, 2018, 28(3): 386-394. DOI: 10.1089/thy.2017.0430. |
| 16. | Khong JJ, Goldstein RF, Sanders KM, et al. Serum selenium status in Graves' disease with and without orbitopathy: a case-control study[J]. Clin Endocrinol (Oxf), 2014, 80(6): 905-910. DOI: 10.1111/cen.12392. |
| 17. | Marcocci C, Kahaly GJ, Krassas GE, et al. Selenium and the course of mild Graves' orbitopathy[J]. N Engl J Med, 2011, 364(20): 1920-1931. DOI: 10.1056/NEJMoa1012985. |
| 18. | Marcocci C, Bartalena L. Role of oxidative stress and selenium in Graves' hyperthyroidism and orbitopathy[J]. J Endocrinol Invest, 2013, 36(10 Suppl): 15-20. |
| 19. | Lanzolla G, Marinò M, Marcocci C. Selenium in the treatment of Graves' hyperthyroidism and eye disease[J/OL]. Front Endocrinol (Lausanne), 2020, 11: 608428[2021-01-26]. https://pubmed.ncbi.nlm.nih.gov/33574798/. DOI: 10.3389/fendo.2020.608428. |
| 20. | Sadaka A, Nguyen K, Malik A, et al. Vitamin D and selenium in a thyroid eye disease population in texas[J]. Neuroophthalmology, 2019, 43(5): 291-294. DOI: 10.1080/01658107.2019.1566382. |
| 21. | Aranow C. Vitamin D and the immune system[J]. J Investig Med, 2011, 59(6): 881-886. DOI: 10.2310/JIM.0b013e31821b8755. |
| 22. | Ramamurthy LB, Rangarajan V, Srirao N, et al. Severity of thyroid eye disease and type-2 diabetes mellitus: is there a correlation?[J]. Indian J Ophthalmol, 2020, 68(6): 1127-1131. DOI: 10.4103/ijo.IJO_1443_19. |
| 23. | Rath S, Pattnaik M, Tripathy D, et al. Sight-threatening thyroid eye disease: role of diabetes mellitus and interaction with other risk factors[J]. Ophthalmic Plast Reconstr Surg, 2021, 37(4): 352-360. DOI: 10.1097/IOP.0000000000001871. |
| 24. | Patel VK, Padnick-silver L, D'souza S, et al. Characteristics of diabetic and nondiabetic patients with thyroid eye disease in the United States: a claims-based analysis[J]. Endocr Pract, 2022, 28(2): 159-164. DOI: 10.1016/j.eprac.2021.11.080. |
| 25. | Godfrey KJ, Schmuter G, Hu B, et al. Prospective correlation of risk of obstructive sleep apnea with severe clinical features of thyroid eye disease[J]. Ophthalmic Plast Reconstr Surg, 2021, 37(3): S58-61. DOI: 10.1097/IOP.0000000000001809. |
| 26. | Habib LA, Godfrey KJ, Mathews P, et al. Association of risk of obstructive sleep apnea with thyroid eye disease: compressive optic neuropathy[J]. Ophthalmic Plast Reconstr Surg, 2019, 35(3): 232-234. DOI: 10.1097/IOP.0000000000001211. |
| 27. | Tomer Y. Mechanisms of autoimmune thyroid diseases: from genetics to epigenetics[J]. Annu Rev Pathol, 2014, 9: 147-156. DOI: 10.1146/annurev-pathol-012513-104713. |
| 28. | Brix TH, Kyvik KO, Christensen K, et al. Evidence for a major role of heredity in Graves' disease: a population-based study of two Danish twin cohorts[J]. J Clin Endocrinol Metab, 2001, 86(2): 930-934. DOI: 10.1210/jcem.86.2.7242. |
| 29. | Lee HJ, Li CW, Hammerstad SS, et al. Immunogenetics of autoimmune thyroid diseases: a comprehensive review[J]. J Autoimmun, 2015, 64: 82-90. DOI: 10.1016/j.jaut.2015.07.009. |
| 30. | Taylor PN, Zhang L, Lee RWJ, et al. New insights into the pathogenesis and nonsurgical management of Graves orbitopathy[J]. Nat Rev Endocrinol, 2020, 16(2): 104-116. DOI: 10.1038/s41574-019-0305-4. |
| 31. | Davies TF, Andersen S, Latif R, et al. Graves' disease[J/OL]. Nat Rev Dis Primers, 2020, 6(1): 52[2020-07-02]. https://pubmed.ncbi.nlm.nih.gov/32616746/. DOI: 10.1038/s41572-020-0184-y. |
| 32. | Stasiak M, Stasiak B, Zawadzka-starczewska K, et al. Significance of HLA in Graves' disease and Graves' orbitopathy in Asian and Caucasian populations-a systematic review[J/OL]. Front Immunol, 2023, 14: 1256922[2023-09-28]. https://pubmed.ncbi.nlm.nih.gov/37841270/. DOI: 10.3389/fimmu.2023.1256922. |
| 33. | 中華醫學會眼科學分會眼整形眼眶病學組, 中華醫學會內分泌學分會甲狀腺學組. 中國甲狀腺相關眼病診斷和治療指南(2022年)[J]. 中華眼科雜志, 2022, 58(9): 646-668. DOI: 10.3760/cma.j.cn112142-20220421-00201.Ophthalmic Plastic Surgery and Orbital Disease Group, Ophthalmology Branch of Chinese Medical Association, Thyroid Group, Endocrinology Branch of Chinese Medical Association. Chinese guideline on the diagnosis and treatment of thyroid-associated ophthalmopathy (2022)[J]. Chin J Ophthalmol, 2022, 58(9): 646-668. DOI: 10.3760/cma.j.cn112142-20220421-00201. |
| 34. | Shabto JM, Stevens S, Kazim M. Thyroid eye disease and ocular myasthenia gravis[J]. Curr Opin Neurol, 2025, 38(1): 71-78. DOI: 10.1097/WCO.0000000000001339. |
| 35. | Munoz-ortiz J, Sierra-cote MC, Zapata-bravo E, et al. Prevalence of hyperthyroidism, hypothyroidism, and euthyroidism in thyroid eye disease: a systematic review of the literature[J/OL]. Syst Rev, 2020, 9(1): 201[2020-09-01]. https://pubmed.ncbi.nlm.nih.gov/32873324/. DOI: 10.1186/s13643-020-01459-7. |
| 36. | Li Z, Cestari DM, Fortin E. Thyroid eye disease: what is new to know?[J]. Curr Opin Ophthalmol, 2018, 29(6): 528-534. DOI: 10.1097/ICU.0000000000000529. |
| 37. | Rana HS, Akella SS, Clabeaux CE, et al. Ocular surface disease in thyroid eye disease: a narrative review[J]. Ocul Surf, 2022, 24: 67-73. DOI: 10.1016/j.jtos.2022.02.001. |
| 38. | Kashkouli MB, Kaghazkanani R, Heidari I, et al. Bilateral versus unilateral thyroid eye disease[J]. Indian J Ophthalmol, 2011, 59(5): 363-366. DOI: 10.4103/0301-4738.83612. |
| 39. | Lu TJ, Amarikwa L, Sears CM, et al. Advances in the treatment of thyroid eye disease associated extraocular muscle myopathy and optic neuropathy[J]. Curr Neurol Neurosci Rep, 2022, 22(6): 313-325. DOI: 10.1007/s11910-022-01194-7. |
| 40. | Mishra S, Maurya VK, Kumar S, et al. Clinical management and therapeutic strategies for the thyroid-associated ophthalmopathy: current and future perspectives[J]. Curr Eye Res, 2020, 45(11): 1325-1341. DOI: 10.1080/02713683.2020.1776331. |
| 41. | Bartalena L, Kahaly GJ, Baldeschi L, et al. The 2021 European Group on Graves' Orbitopathy (EUGOGO) clinical practice guidelines for the medical management of Graves' orbitopathy[J]. Eur J Endocrinol, 2021, 185(4): 43-67. DOI: 10.1530/EJE-21-0479. |
| 42. | Moeen Z, Aliuddin AM, Gray WT, et al. An interesting case of euthyroid Graves' ophthalmopathy, with negative thyroid-stimulating hormone receptor antibodies[J/OL]. Cureus, 2021, 13(10): e19015[2021-10-24]. https://pubmed.ncbi.nlm.nih.gov/34853745/. DOI: 10.7759/cureus.19015. |
| 43. | Takahashi Y, Vaidya A, Kakizaki H. Risk factors for development of superior limbic keratoconjunctivitis in thyroid eye disease in Japanese[J]. Graefe's Arch Clin Exp Ophthalmol, 2023, 261(3): 833-839. DOI: 10.1007/s00417-022-05827-y. |
| 44. | Liu P, Chen L, Wang QX, et al. Histogram analysis of T2 mapping for detecting early involvement of extraocular muscles in patients with thyroid-associated ophthalmopathy[J/OL]. Sci Rep, 2020, 10(1): 19445[2020-11-10]. https://pubmed.ncbi.nlm.nih.gov/33173086/. DOI: 10.1038/s41598-020-76341-6. |
| 45. | Blandford AD, Zhang D, Chundury RV, et al. Dysthyroid optic neuropathy: update on pathogenesis, diagnosis, and management[J]. Expert Rev Ophthalmol, 2017, 12(2): 111-121. DOI: 10.1080/17469899.2017.1276444. |
| 46. | 中華醫學會內分泌學分會, 中國醫師協會內分泌代謝科醫師分會, 中華醫學會核醫學分會, 等. 中國甲狀腺功能亢進癥和其他原因所致甲狀腺毒癥診治指南[J]. 國際內分泌代謝雜志, 2022, 42(5): 401-450. DOI: 10.3760/cma.j.cn311282-20220624-00404-1.Chinese Society of Endocrinology, Chinese Endocrinologist Association, Chinese Society of Nuclear Medicine, et al. Guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis[J]. Int J Endocrinol Metab, 2022, 42(5): 401-450. DOI: 10.3760/cma.j.cn311282-20220624-00404-1. |
| 47. | Taylor PN, Medici MM, Hubalewska-Dydejczyk A, et al. Hypothyroidism[J]. Lancet, 2024, 404(10460): 1347-1364. DOI: 10.1016/S0140-6736(24)01614-3. |
| 48. | Wang JM, Edwards B, Tardieu GG, et al. More than meets the eye: the contributions of John Dalrymple (1803-1852)[J/OL]. Cureus, 2017, 9(6): e1366[2017-06-19]. https://pubmed.ncbi.nlm.nih.gov/28744413/. DOI: 10.7759/cureus.1366. |
| 49. | Abboud JJ, Badawe H, Nguyen J, et al. Kinematics of the upper eyelid and the globe during downward excursion with comparative analysis in patients with thyroid eye disease[J]. Ophthalmic Plast Reconstr Surg, 2024, 40(2): 167-173. DOI: 10.1097/IOP.0000000000002517. |
| 50. | Dolman PJ. Dysthyroid optic neuropathy: evaluation and management[J]. J Endocrinol Invest, 2021, 44(3): 421-429. DOI: 10.1007/s40618-020-01361-y. |
| 51. | Betzler BK, Young SM, Sundar G. Intraocular pressure and glaucoma in thyroid eye disease[J]. Ophthalmic Plast Reconstr Surg, 2022, 38(3): 219-225. DOI: 10.1097/IOP.0000000000002049. |
| 52. | Wu D, Liu X, Wu D, et al. Normal values of Hertel exophthalmometry in a Chinese Han population from Shenyang, Northeast China[J/OL]. Sci Rep, 2015, 5: 8526[2015-02-23]. https://pubmed.ncbi.nlm.nih.gov/25703959/. DOI: 10.1038/srep08526. |
| 53. | Sio SWC, Chan BKT, Aljufairi F, et al. Diagnostic methods for dysthyroid optic neuropathy: a systematic review and analysis[J]. Surv Ophthalmol, 2024, 69(3): 403-410. DOI: 10.1016/j.survophthal.2023.11.009. |
| 54. | Hsu CK, Yao HY, Lin CM, et al. Characteristics of optic disc and visual field changes in patients with thyroid-associated orbitopathy and open-angle glaucoma[J/OL]. J Clin Med, 2021, 10(17): 3839[2021-08-27]. https://pubmed.ncbi.nlm.nih.gov/34501289/. DOI: 10.3390/jcm10173839. |
| 55. | Choi CJ, Oropesa S, Callahan AB, et al. Patterns of visual field changes in thyroid eye disease[J]. Orbit, 2017, 36(4): 201-207. DOI: 10.1080/01676830.2017.1314510. |
| 56. | Rajabi MT, Sadeghi R, Abdol Homayuni MR, et al. Optical coherence tomography angiography in thyroid associated ophthalmopathy: a systematic review[J/OL]. BMC Ophthalmol, 2024, 24(1): 304[2024-07-22]. https://pubmed.ncbi.nlm.nih.gov/39039451/. DOI: 10.1186/s12886-024-03569-5. |
| 57. | Goel R, Shah S, Sundar G, et al. Orbital and ocular perfusion in thyroid eye disease[J]. Surv Ophthalmol, 2023, 68(3): 481-506. DOI: 10.1016/j.survophthal.2023.01.003. |
| 58. | Yu L, Jiao Q, Cheng Y, et al. Evaluation of retinal and choroidal variations in thyroid-associated ophthalmopathy using optical coherence tomography angiography[J/OL]. BMC Ophthalmol, 2020, 20(1): 421[2020-10-20]. https://pubmed.ncbi.nlm.nih.gov/33081749/. DOI: 10.1186/s12886-020-01692-7. |
| 59. | Jamshidian Tehrani M, Mahdizad Z, Kasaei A, et al. Early macular and peripapillary vasculature dropout in active thyroid eye disease[J]. Graefe's Arch Clin Exp Ophthalmol, 2019, 257(11): 2533-2540. DOI: 10.1007/s00417-019-04442-8. |
| 60. | Novais EA, Roisman L, De Oliveira PR, et al. Optical coherence tomography angiography of chorioretinal diseases[J]. Ophthalmic Surg Lasers Imaging Retina, 2016, 47(9): 848-861. DOI: 10.3928/23258160-20160901-09. |
| 61. | Gon?alves AC, Gebrim EM, Monteiro M. Imaging studies for diagnosing Graves' orbitopathy and dysthyroid optic neuropathy[J]. Clinics (Sao Paulo), 2012, 67(11): 1327-1334. DOI: 10.6061/clinics. |
| 62. | Smith TJ, Hegedüs L. Graves' disease[J]. N Engl J Med, 2016, 375(16): 1552-1565. DOI: 10.1056/NEJMra1510030. |
| 63. | Gupta AK, Kumar S. Utility of antibodies in the diagnoses of thyroid diseases: a review article[J/OL]. Cureus, 2022, 14(11): e31233[2022-11-08]. https://pubmed.ncbi.nlm.nih.gov/36514581/. DOI: 10.7759/cureus.31233. |
| 64. | Mourits MP, Koornneef L, Wiersinga WM, et al. Clinical criteria for the assessment of disease activity in Graves' ophthalmopathy: a novel approach[J]. Br J Ophthalmol, 1989, 73(8): 639-644. DOI: 10.1136/bjo.73.8.639. |
| 65. | Bartalena L, Baldeschi L, Boboridis K, et al. The 2016 European Thyroid Association/European Group on Graves' orbitopathy guidelines for the management of Graves' orbitopathy[J]. Eur Thyroid J, 2016, 5(1): 9-26. DOI: 10.1159/000443828. |
| 66. | Werner SC. Modification of the classification of the eye changes of Graves' disease: recommendations of the Ad Hoc Committee of the American Thyroid Association[J]. J Clin Endocrinol Metab, 1977, 44(1): 203-204. DOI: 10.1210/jcem-44-1-203. |
- 1. Burch HB, Perros P, Bednarcauk T, et al. Management of thyroid eye disease: a consensus statement by the American Thyroid Association and the European Thyroid Association[J]. Thyroid, 2022, 32(12): 1439-1470. DOI: 10.1530/ETJ-22-0189.
- 2. Moledina M, Damato EM, Lee V. The changing landscape of thyroid eye disease: current clinical advances and future outlook[J]. Eye (Lond), 2024, 38(8): 1425-1437. DOI: 10.1038/s41433-024-02967-9.
- 3. Wiersinga WM, Eckstein AK, ?arkovi? M. Thyroid eye disease (Graves' orbitopathy): clinical presentation, epidemiology, pathogenesis, and management[J]. Lancet Diabetes Endocrinol, 2025, 13(7): 600-614. DOI: 10.1016/S2213-8587(25)00066-X.
- 4. Yu CY, Ford RL, Wester ST, et al. Update on thyroid eye disease: regional variations in prevalence, diagnosis, and management[J]. Indian J Ophthalmol, 2022, 70(7): 2335-2345. DOI: 10.4103/ijo.IJO_3217_21.
- 5. Wagner LH, Bradley EA, Tooley AA, et al. Thyroid eye disease or Graves' orbitopathy: what name to use, and why it matters[J/OL]. Front Endocrinol (Lausanne), 2022, 13: 1083886[2020-11-28]. https://pubmed.ncbi.nlm.nih.gov/36518254/. DOI: 10.3389/fendo.2022.1083886.
- 6. Ing EB, Madjedi K, Hurwitz JJ, et al. Nomenclature: thyroid-associated orbitopathy, Graves ophthalmopathy, or thyroid eye disease?[J/OL]. Can J Ophthalmol, 2021, 56(1): e22-e24[2020-07-20]. https://linkinghub.elsevier.com/retrieve/pii/S0008-4182(20)30624-4. DOI: 10.1016/j.jcjo.2020.06.004.
- 7. Rundle FF, Wilson CW. Development and course of exophthalmos and ophthalmoplegia in Graves' disease with special reference to the effect of thyroidectomy[J]. Clin Sci, 1945, 5(3-4): 177-194.
- 8. Bartley GB. Rundle and his curve[J]. Arch Ophthalmol, 2011, 129(3): 356-358. DOI: 10.1001/archophthalmol.
- 9. Bartalena L, Piantanida E, Gallo D, et al. Epidemiology, natural history, risk factors, and prevention of Graves' orbitopathy[J/OL]. Front Endocrinol (Lausanne), 2020, 11: 615993[2020-11-30]. https://pubmed.ncbi.nlm.nih.gov/33329408/. DOI: 10.3389/fendo.2020.615993.
- 10. Hegediüs L, Brix TH, Vestergaard P. Relationship between cigarette smoking and Graves' ophthalmopathy[J]. J Endocrinol Invest, 2004, 27(3): 265-271. DOI: 10.1007/BF03345276.
- 11. Xing L, Ye L, Zhu W, et al. Smoking was associated with poor response to intravenous steroids therapy in Graves' ophthalmopathy[J]. Br J Ophthalmol, 2015, 99(12): 1686-1691. DOI: 10.1136/bjophthalmol-2014-306463.
- 12. Cardo C, Bernardo Santos R, Pinotti Pedro Miklos AB, et al. The relationship between cholesterol levels and thyroid eye disease[J/OL]. Eur Thyroid J, 2025, 14(1): e240133[2025-02-03]. https://pubmed.ncbi.nlm.nih.gov/39819487/. DOI: 10.1530/ETJ-24-0133.
- 13. Liu J, Zhu T, Yang L, et al. Cigarette smoking drives thyroid eye disease progression via RAGE signaling activation[J]. Thyroid, 2025, 35(7): 803-815. DOI: 0.1089/thy.2025.0062.
- 14. Lanzolla G, Vannucchi G, Ionni I, et al. Cholesterol serum levels and use of statins in Graves' orbitopathy: a new starting point for the therapy[J/OL]. Front Endocrinol (Lausanne), 2020, 10: 933[2020-01-22]. https://pubmed.ncbi.nlm.nih.gov/32038490/. DOI: 10.3389/fendo.2019.00933.
- 15. Sabini E, Mazzi B, Profilo MA, et al. High serum cholesterol is a novel risk factor for Graves' orbitopathy: results of a cross-sectional study[J]. Thyroid, 2018, 28(3): 386-394. DOI: 10.1089/thy.2017.0430.
- 16. Khong JJ, Goldstein RF, Sanders KM, et al. Serum selenium status in Graves' disease with and without orbitopathy: a case-control study[J]. Clin Endocrinol (Oxf), 2014, 80(6): 905-910. DOI: 10.1111/cen.12392.
- 17. Marcocci C, Kahaly GJ, Krassas GE, et al. Selenium and the course of mild Graves' orbitopathy[J]. N Engl J Med, 2011, 364(20): 1920-1931. DOI: 10.1056/NEJMoa1012985.
- 18. Marcocci C, Bartalena L. Role of oxidative stress and selenium in Graves' hyperthyroidism and orbitopathy[J]. J Endocrinol Invest, 2013, 36(10 Suppl): 15-20.
- 19. Lanzolla G, Marinò M, Marcocci C. Selenium in the treatment of Graves' hyperthyroidism and eye disease[J/OL]. Front Endocrinol (Lausanne), 2020, 11: 608428[2021-01-26]. https://pubmed.ncbi.nlm.nih.gov/33574798/. DOI: 10.3389/fendo.2020.608428.
- 20. Sadaka A, Nguyen K, Malik A, et al. Vitamin D and selenium in a thyroid eye disease population in texas[J]. Neuroophthalmology, 2019, 43(5): 291-294. DOI: 10.1080/01658107.2019.1566382.
- 21. Aranow C. Vitamin D and the immune system[J]. J Investig Med, 2011, 59(6): 881-886. DOI: 10.2310/JIM.0b013e31821b8755.
- 22. Ramamurthy LB, Rangarajan V, Srirao N, et al. Severity of thyroid eye disease and type-2 diabetes mellitus: is there a correlation?[J]. Indian J Ophthalmol, 2020, 68(6): 1127-1131. DOI: 10.4103/ijo.IJO_1443_19.
- 23. Rath S, Pattnaik M, Tripathy D, et al. Sight-threatening thyroid eye disease: role of diabetes mellitus and interaction with other risk factors[J]. Ophthalmic Plast Reconstr Surg, 2021, 37(4): 352-360. DOI: 10.1097/IOP.0000000000001871.
- 24. Patel VK, Padnick-silver L, D'souza S, et al. Characteristics of diabetic and nondiabetic patients with thyroid eye disease in the United States: a claims-based analysis[J]. Endocr Pract, 2022, 28(2): 159-164. DOI: 10.1016/j.eprac.2021.11.080.
- 25. Godfrey KJ, Schmuter G, Hu B, et al. Prospective correlation of risk of obstructive sleep apnea with severe clinical features of thyroid eye disease[J]. Ophthalmic Plast Reconstr Surg, 2021, 37(3): S58-61. DOI: 10.1097/IOP.0000000000001809.
- 26. Habib LA, Godfrey KJ, Mathews P, et al. Association of risk of obstructive sleep apnea with thyroid eye disease: compressive optic neuropathy[J]. Ophthalmic Plast Reconstr Surg, 2019, 35(3): 232-234. DOI: 10.1097/IOP.0000000000001211.
- 27. Tomer Y. Mechanisms of autoimmune thyroid diseases: from genetics to epigenetics[J]. Annu Rev Pathol, 2014, 9: 147-156. DOI: 10.1146/annurev-pathol-012513-104713.
- 28. Brix TH, Kyvik KO, Christensen K, et al. Evidence for a major role of heredity in Graves' disease: a population-based study of two Danish twin cohorts[J]. J Clin Endocrinol Metab, 2001, 86(2): 930-934. DOI: 10.1210/jcem.86.2.7242.
- 29. Lee HJ, Li CW, Hammerstad SS, et al. Immunogenetics of autoimmune thyroid diseases: a comprehensive review[J]. J Autoimmun, 2015, 64: 82-90. DOI: 10.1016/j.jaut.2015.07.009.
- 30. Taylor PN, Zhang L, Lee RWJ, et al. New insights into the pathogenesis and nonsurgical management of Graves orbitopathy[J]. Nat Rev Endocrinol, 2020, 16(2): 104-116. DOI: 10.1038/s41574-019-0305-4.
- 31. Davies TF, Andersen S, Latif R, et al. Graves' disease[J/OL]. Nat Rev Dis Primers, 2020, 6(1): 52[2020-07-02]. https://pubmed.ncbi.nlm.nih.gov/32616746/. DOI: 10.1038/s41572-020-0184-y.
- 32. Stasiak M, Stasiak B, Zawadzka-starczewska K, et al. Significance of HLA in Graves' disease and Graves' orbitopathy in Asian and Caucasian populations-a systematic review[J/OL]. Front Immunol, 2023, 14: 1256922[2023-09-28]. https://pubmed.ncbi.nlm.nih.gov/37841270/. DOI: 10.3389/fimmu.2023.1256922.
- 33. 中華醫學會眼科學分會眼整形眼眶病學組, 中華醫學會內分泌學分會甲狀腺學組. 中國甲狀腺相關眼病診斷和治療指南(2022年)[J]. 中華眼科雜志, 2022, 58(9): 646-668. DOI: 10.3760/cma.j.cn112142-20220421-00201.Ophthalmic Plastic Surgery and Orbital Disease Group, Ophthalmology Branch of Chinese Medical Association, Thyroid Group, Endocrinology Branch of Chinese Medical Association. Chinese guideline on the diagnosis and treatment of thyroid-associated ophthalmopathy (2022)[J]. Chin J Ophthalmol, 2022, 58(9): 646-668. DOI: 10.3760/cma.j.cn112142-20220421-00201.
- 34. Shabto JM, Stevens S, Kazim M. Thyroid eye disease and ocular myasthenia gravis[J]. Curr Opin Neurol, 2025, 38(1): 71-78. DOI: 10.1097/WCO.0000000000001339.
- 35. Munoz-ortiz J, Sierra-cote MC, Zapata-bravo E, et al. Prevalence of hyperthyroidism, hypothyroidism, and euthyroidism in thyroid eye disease: a systematic review of the literature[J/OL]. Syst Rev, 2020, 9(1): 201[2020-09-01]. https://pubmed.ncbi.nlm.nih.gov/32873324/. DOI: 10.1186/s13643-020-01459-7.
- 36. Li Z, Cestari DM, Fortin E. Thyroid eye disease: what is new to know?[J]. Curr Opin Ophthalmol, 2018, 29(6): 528-534. DOI: 10.1097/ICU.0000000000000529.
- 37. Rana HS, Akella SS, Clabeaux CE, et al. Ocular surface disease in thyroid eye disease: a narrative review[J]. Ocul Surf, 2022, 24: 67-73. DOI: 10.1016/j.jtos.2022.02.001.
- 38. Kashkouli MB, Kaghazkanani R, Heidari I, et al. Bilateral versus unilateral thyroid eye disease[J]. Indian J Ophthalmol, 2011, 59(5): 363-366. DOI: 10.4103/0301-4738.83612.
- 39. Lu TJ, Amarikwa L, Sears CM, et al. Advances in the treatment of thyroid eye disease associated extraocular muscle myopathy and optic neuropathy[J]. Curr Neurol Neurosci Rep, 2022, 22(6): 313-325. DOI: 10.1007/s11910-022-01194-7.
- 40. Mishra S, Maurya VK, Kumar S, et al. Clinical management and therapeutic strategies for the thyroid-associated ophthalmopathy: current and future perspectives[J]. Curr Eye Res, 2020, 45(11): 1325-1341. DOI: 10.1080/02713683.2020.1776331.
- 41. Bartalena L, Kahaly GJ, Baldeschi L, et al. The 2021 European Group on Graves' Orbitopathy (EUGOGO) clinical practice guidelines for the medical management of Graves' orbitopathy[J]. Eur J Endocrinol, 2021, 185(4): 43-67. DOI: 10.1530/EJE-21-0479.
- 42. Moeen Z, Aliuddin AM, Gray WT, et al. An interesting case of euthyroid Graves' ophthalmopathy, with negative thyroid-stimulating hormone receptor antibodies[J/OL]. Cureus, 2021, 13(10): e19015[2021-10-24]. https://pubmed.ncbi.nlm.nih.gov/34853745/. DOI: 10.7759/cureus.19015.
- 43. Takahashi Y, Vaidya A, Kakizaki H. Risk factors for development of superior limbic keratoconjunctivitis in thyroid eye disease in Japanese[J]. Graefe's Arch Clin Exp Ophthalmol, 2023, 261(3): 833-839. DOI: 10.1007/s00417-022-05827-y.
- 44. Liu P, Chen L, Wang QX, et al. Histogram analysis of T2 mapping for detecting early involvement of extraocular muscles in patients with thyroid-associated ophthalmopathy[J/OL]. Sci Rep, 2020, 10(1): 19445[2020-11-10]. https://pubmed.ncbi.nlm.nih.gov/33173086/. DOI: 10.1038/s41598-020-76341-6.
- 45. Blandford AD, Zhang D, Chundury RV, et al. Dysthyroid optic neuropathy: update on pathogenesis, diagnosis, and management[J]. Expert Rev Ophthalmol, 2017, 12(2): 111-121. DOI: 10.1080/17469899.2017.1276444.
- 46. 中華醫學會內分泌學分會, 中國醫師協會內分泌代謝科醫師分會, 中華醫學會核醫學分會, 等. 中國甲狀腺功能亢進癥和其他原因所致甲狀腺毒癥診治指南[J]. 國際內分泌代謝雜志, 2022, 42(5): 401-450. DOI: 10.3760/cma.j.cn311282-20220624-00404-1.Chinese Society of Endocrinology, Chinese Endocrinologist Association, Chinese Society of Nuclear Medicine, et al. Guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis[J]. Int J Endocrinol Metab, 2022, 42(5): 401-450. DOI: 10.3760/cma.j.cn311282-20220624-00404-1.
- 47. Taylor PN, Medici MM, Hubalewska-Dydejczyk A, et al. Hypothyroidism[J]. Lancet, 2024, 404(10460): 1347-1364. DOI: 10.1016/S0140-6736(24)01614-3.
- 48. Wang JM, Edwards B, Tardieu GG, et al. More than meets the eye: the contributions of John Dalrymple (1803-1852)[J/OL]. Cureus, 2017, 9(6): e1366[2017-06-19]. https://pubmed.ncbi.nlm.nih.gov/28744413/. DOI: 10.7759/cureus.1366.
- 49. Abboud JJ, Badawe H, Nguyen J, et al. Kinematics of the upper eyelid and the globe during downward excursion with comparative analysis in patients with thyroid eye disease[J]. Ophthalmic Plast Reconstr Surg, 2024, 40(2): 167-173. DOI: 10.1097/IOP.0000000000002517.
- 50. Dolman PJ. Dysthyroid optic neuropathy: evaluation and management[J]. J Endocrinol Invest, 2021, 44(3): 421-429. DOI: 10.1007/s40618-020-01361-y.
- 51. Betzler BK, Young SM, Sundar G. Intraocular pressure and glaucoma in thyroid eye disease[J]. Ophthalmic Plast Reconstr Surg, 2022, 38(3): 219-225. DOI: 10.1097/IOP.0000000000002049.
- 52. Wu D, Liu X, Wu D, et al. Normal values of Hertel exophthalmometry in a Chinese Han population from Shenyang, Northeast China[J/OL]. Sci Rep, 2015, 5: 8526[2015-02-23]. https://pubmed.ncbi.nlm.nih.gov/25703959/. DOI: 10.1038/srep08526.
- 53. Sio SWC, Chan BKT, Aljufairi F, et al. Diagnostic methods for dysthyroid optic neuropathy: a systematic review and analysis[J]. Surv Ophthalmol, 2024, 69(3): 403-410. DOI: 10.1016/j.survophthal.2023.11.009.
- 54. Hsu CK, Yao HY, Lin CM, et al. Characteristics of optic disc and visual field changes in patients with thyroid-associated orbitopathy and open-angle glaucoma[J/OL]. J Clin Med, 2021, 10(17): 3839[2021-08-27]. https://pubmed.ncbi.nlm.nih.gov/34501289/. DOI: 10.3390/jcm10173839.
- 55. Choi CJ, Oropesa S, Callahan AB, et al. Patterns of visual field changes in thyroid eye disease[J]. Orbit, 2017, 36(4): 201-207. DOI: 10.1080/01676830.2017.1314510.
- 56. Rajabi MT, Sadeghi R, Abdol Homayuni MR, et al. Optical coherence tomography angiography in thyroid associated ophthalmopathy: a systematic review[J/OL]. BMC Ophthalmol, 2024, 24(1): 304[2024-07-22]. https://pubmed.ncbi.nlm.nih.gov/39039451/. DOI: 10.1186/s12886-024-03569-5.
- 57. Goel R, Shah S, Sundar G, et al. Orbital and ocular perfusion in thyroid eye disease[J]. Surv Ophthalmol, 2023, 68(3): 481-506. DOI: 10.1016/j.survophthal.2023.01.003.
- 58. Yu L, Jiao Q, Cheng Y, et al. Evaluation of retinal and choroidal variations in thyroid-associated ophthalmopathy using optical coherence tomography angiography[J/OL]. BMC Ophthalmol, 2020, 20(1): 421[2020-10-20]. https://pubmed.ncbi.nlm.nih.gov/33081749/. DOI: 10.1186/s12886-020-01692-7.
- 59. Jamshidian Tehrani M, Mahdizad Z, Kasaei A, et al. Early macular and peripapillary vasculature dropout in active thyroid eye disease[J]. Graefe's Arch Clin Exp Ophthalmol, 2019, 257(11): 2533-2540. DOI: 10.1007/s00417-019-04442-8.
- 60. Novais EA, Roisman L, De Oliveira PR, et al. Optical coherence tomography angiography of chorioretinal diseases[J]. Ophthalmic Surg Lasers Imaging Retina, 2016, 47(9): 848-861. DOI: 10.3928/23258160-20160901-09.
- 61. Gon?alves AC, Gebrim EM, Monteiro M. Imaging studies for diagnosing Graves' orbitopathy and dysthyroid optic neuropathy[J]. Clinics (Sao Paulo), 2012, 67(11): 1327-1334. DOI: 10.6061/clinics.
- 62. Smith TJ, Hegedüs L. Graves' disease[J]. N Engl J Med, 2016, 375(16): 1552-1565. DOI: 10.1056/NEJMra1510030.
- 63. Gupta AK, Kumar S. Utility of antibodies in the diagnoses of thyroid diseases: a review article[J/OL]. Cureus, 2022, 14(11): e31233[2022-11-08]. https://pubmed.ncbi.nlm.nih.gov/36514581/. DOI: 10.7759/cureus.31233.
- 64. Mourits MP, Koornneef L, Wiersinga WM, et al. Clinical criteria for the assessment of disease activity in Graves' ophthalmopathy: a novel approach[J]. Br J Ophthalmol, 1989, 73(8): 639-644. DOI: 10.1136/bjo.73.8.639.
- 65. Bartalena L, Baldeschi L, Boboridis K, et al. The 2016 European Thyroid Association/European Group on Graves' orbitopathy guidelines for the management of Graves' orbitopathy[J]. Eur Thyroid J, 2016, 5(1): 9-26. DOI: 10.1159/000443828.
- 66. Werner SC. Modification of the classification of the eye changes of Graves' disease: recommendations of the Ad Hoc Committee of the American Thyroid Association[J]. J Clin Endocrinol Metab, 1977, 44(1): 203-204. DOI: 10.1210/jcem-44-1-203.