Phenotypes of Thyroid Eye Disease

Area of Science:

• Ophthalmology
• Endocrinology
• Medical Imaging

Background:

• Thyroid eye disease (TED) presents with heterogeneous clinical manifestations and variable treatment responses.
• Existing TED classifications are often dichotomous and fail to capture the full spectrum of the disease's heterogeneity.

Purpose of the Study:

• To introduce a novel classification system for thyroid eye disease (TED).
• The system categorizes TED based on distinct phenotypic features, incorporating both clinical and radiologic data.

Main Methods:

• Analysis of clinical features, photographic documentation, and orbital imaging in TED patients.
• Correlation of phenotypic characteristics with disease natural history and treatment outcomes.
• Identification and description of phenotypically distinct patient categories.

Main Results:

• Six distinct phenotypes of TED were identified and described.
• These include congestive (active inflammatory), "white eye" expansion, "hydraulic" apex, "white eye" apex, cicatricial active, and cicatricial passive phenotypes.

Conclusions:

• The observable characteristics of TED are linked to its underlying pathophysiology.
• This new classification acknowledges TED's heterogeneity in pathogenesis, clinical presentation, and treatment response.
• The proposed system offers a more comprehensive approach to understanding and managing TED compared to previous dichotomous categorizations.