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Graves' orbitopathy — SCE Endocrinology MCQ

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HardThyroidGraves' orbitopathySCE Endocrinology

A 34-year-old woman has Graves' disease and severe active orbitopathy with diplopia. TSH is suppressed and free T4 is 38 pmol/L. She smokes 15 cigarettes daily. What is the most appropriate management priority?

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Correct answer: C — Urgent combined thyroid-eye clinic care, smoking cessation and control of thyrotoxicosis while treating active orbitopathy

Urgent combined thyroid-eye clinic care, smoking cessation and control of thyrotoxicosis while treating active orbitopathy is best because active moderate-to-severe Graves' orbitopathy needs specialist eye-thyroid care, smoking cessation and restoration of euthyroidism. The alternatives are less appropriate because radioiodine may worsen orbitopathy; levothyroxine suppression is wrong; observation risks visual morbidity; cosmetic surgery waits until inflammation is controlled unless sight-threatening disease dictates otherwise. The SCE teaching point is to integrate the clinical pattern, biochemistry and context rather than treating an isolated result.

Reference: European Thyroid Association Graves' orbitopathy guidance; NICE NG145