Thyroid eye disease: Primary care recognition and referral

Thyroid eye disease (TED) is a potentially sight-threatening autoimmune condition affecting up to half of patients with Graves' disease. It presents with variable ocular symptoms such as lid retraction, proptosis, diplopia and discomfort, which can significantly impair vision and quality of life. Early detection is crucial, as prompt management can prevent progression and visual loss.

This article provides general practitioners (GPs) with a framework to recognise, assess and initiate management of TED, and it outlines appropriate referral pathways to specialist care.

GPs play an essential part in screening patients with thyroid disease for TED and identifying early warning signs. Initial measures include smoking cessation, restoration of euthyroid status and use of lubricants. Urgent referral is warranted for sight-threatening or rapidly progressive disease, while coordinated multidisciplinary management with endocrinologists and ophthalmologists supports optimal outcomes. Early recognition and referral by GPs can significantly improve visual and quality-of-life outcomes.