Graves' disease with thyroid eye disease — SCE Endocrinology MCQ

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HardThyroidGraves' disease with thyroid eye diseaseSCE Endocrinology

A 31-year-old woman has weight loss, tremor and palpitations. TSH is <0.01 mU/L, free T4 is 43 pmol/L and TSH receptor antibodies are positive. She has painful red eyes, diplopia on upgaze and smokes 20 cigarettes daily. What is the most appropriate management?

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Correct answer: E — Start antithyroid drug treatment and urgently refer for thyroid eye disease assessment

Graves' thyrotoxicosis with active eye disease requires control of thyrotoxicosis and urgent ophthalmology/endocrine assessment; radioiodine may worsen active ophthalmopathy, especially in smokers. Levothyroxine is inappropriate in biochemical hyperthyroidism. The pearl is that eye disease changes the treatment hierarchy.

Reference: NICE NG145, European Group on Graves' Orbitopathy guidance