The predictive, preventive, and personalised medicine of thyroid eye disease: a comprehensive guide to risk...

Thyroid eye disease (TED) is a prevalent autoimmune orbital disorder that significantly impairs visual function and appearance, adversely affecting patients' quality of life. The development of effective preventive strategies is paramount to optimizing clinical outcomes and disease management. Within the paradigm of predictive, preventive, and personalised medicine (3PM), the identification of modifiable risk factors for TED and the formulation of individualized prevention protocols are critical for targeted risk minimization. However, despite advances in understanding TED pathogenesis, the susceptible populations of TED remain inadequately defined, resulting in generalized and often ineffective preventive measures. Furthermore, while several risk factors for TED development have been identified, particularly tobacco exposure, radioiodine treatment and thyroid dysfunction, their differential contributions across distinct disease courses (onset, progression, and recurrence) remain poorly elucidated. This review comprehensively summarizes current clinical evidence on susceptible populations for TED and classifies modifiable risk factors into five categories: physical and chemical factors, endocrine and autoimmune factors, metabolic and nutritional factors, social and psychological factors, and other factors, with updated clinical evidence of their impacts on disease course. Building upon contemporary clinical evidence, we present a stratified strategy for TED prevention spanning onset, progression, and recurrence that tailored to disease phase-specific vulnerabilities. Early identification and mitigation of modifiable risk factors are pivotal to transitioning TED management from reactive medical services to a 3PM paradigm, ultimately reducing disease incidence, improving clinical outcomes and patients' quality of life.