A Korean Clinical Practice Framework for Thyroid Eye Disease: Integrating International Recommendations with...

Thyroid eye disease (TED), the most common extrathyroidal manifestation of Graves' disease, requires individualized management that integrates medical, radiotherapeutic, and surgical interventions. In this article, we present a society-endorsed, survey-informed Korean clinical practice framework, including consensus elements, for TED management. This framework integrates the 2022 American Thyroid Association/European Thyroid Association consensus, the 2021 European Group on Graves' Orbitopathy (EUGOGO) guideline, and contemporary Korean specialist practice patterns. A 2025 nationwide survey of 32 members of the Korean Society of Ophthalmic Plastic and Reconstructive Surgery characterized current Korean practice patterns in TED management. Korean oculoplastic surgeons showed high adherence to international recommendations, with 87.5% using both the clinical activity score and EUGOGO severity classification and 96.9% administering intravenous glucocorticoid therapy according to EUGOGO protocols. Distinctive features of Korean practice included frequent use of orbital radiotherapy (90.6%) and regional triamcinolone injections (81.2%) in selected clinical settings. For dysthyroid optic neuropathy, 59.4% of respondents reported using combined intravenous glucocorticoid therapy and orbital radiotherapy as the initial treatment approach. This framework stratifies treatment according to disease activity, severity, and predominant clinical phenotype to support context-adapted therapeutic decision-making. As emerging therapies such as teprotumumab become more accessible, this Korean clinical practice framework may provide practical guidance tailored to local clinical practice and healthcare-system constraints.