Address modifiable risk factors for effective thyroid eye disease management

Key takeaways:

• Modifiable risk factors for thyroid eye disease include smoking habits and patient endocrine status.
• Avoid treating patients with active TED with radioactive iodine ablation.

KOLOA, Hawaii — Effective management of thyroid eye disease requires a focus on mitigating modifiable risk factors, according to a presenter at Hawaiian Eye 2025.

Mark J. Lucarelli, MD, FACS, said that the most prominent modifiable risk factors for thyroid eye disease (TED) are the patient’s smoking habits and endocrine status.

“This is a big inflection point that we can have an impact on in the patient’s disease progression,” he said.

According to Lucarelli, the association between smoking and the risk of TED is dose-dependent, meaning that even small adjustments in smoking habits can reduce the level of risk for developing proptosis.

“It doesn’t have to be all or none,” he said. “If we can get the patient from 20 or more cigarettes a day down to one, then you see a profound reduction in the risk.”

Lucarelli also warned ophthalmologists about the association between radioactive iodine ablation and a potential worsening of TED. He recommended that patients with active TED should be encouraged away from treatment with radioactive iodine, “unless they’re going to be prophylactically covered.”

In addition, patients with TED must understand the impact that their endocrine status has on the severity of their eye disease and remain compliant in managing their thyroid dysfunction. Lucarelli recommended encouraging patients who are “all over the map” with their endocrine status to consider surgical thyroidectomy.

“We can really stack the deck if we’re vigilant, encouraging and supportive and we communicate to the other providers about the importance of these factors, because I think many of these are still not very well or not widely understood by some of the other providers that take care of these patients,” he said.

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Sources/Disclosures

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Source:

Lucarelli MJ. Thyroid eye disease. Presented at: Hawaiian Eye 2025; Jan. 18-24, 2025; Koloa, Hawaii.

Disclosures:
Lucarelli reports consulting for Amgen and Viridian Therapeutics as well as being an investigator for Sling Therapeutics and Immunovant.

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