Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 7 Sept 2026Clinical review pending
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Suspected dysthyroid optic neuropathy
New colour desaturation, reduced acuity, a field defect or a relative afferent pupil defect in thyroid eye disease may indicate optic-nerve compression, even without striking proptosis.
Action: Arrange immediate ophthalmology assessment, document visual function and protect an exposed cornea; urgent specialist steroid treatment and possible decompression must not wait for routine thyroid follow-up.
Synopsis
Recognise thyroid-related orbital disease, distinguish inflammatory activity from severity, and identify sight-threatening complications requiring immediate specialist care.
Thyroid eye disease can occur with normal thyroid function.
Activity describes inflammation; severity describes functional and anatomical impact.
Smoking increases risk and worsens the clinical course.
Key red flags
New reduction in vision, colour discrimination or visual field.
Investigation priorities
01
Structured ophthalmic baselineFirst step
Measure function, exposure and anatomical change for subsequent comparison.
Management branches
Mild diseaseProtect comfort and identify progression
Surface symptoms or mild changes without threatening visual features.
Coordinate thyroid assessment and offer practical support to stop smoking.
Use lubricants and address nocturnal exposure with the eye team.
Key medicines
Intravenous methylprednisolone for active moderate-to-severe diseaseA standard EUGOGO course is 500 mg intravenously weekly for six weeks, then 250 mg weekly for six weeks: 4.5 g total.
Mycophenolate sodium or mycophenolate mofetilEUGOGO adjunct: enteric-coated mycophenolate sodium 360 mg orally twice daily, totalling 720 mg/day for 24 weeks. If unavailable, the equivalent mofetil regimen is 500 mg twice daily, totalling 1 g/day.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 7 Sept 2026; clinical approval remains outstanding.
NICE teprotumumab appraisal in developmentChecked 7 September 2026: appraisal remains in development, with expected publication 8 October 2026; not final prescribing guidance.
Myfortic current UK product informationUpdated May 2026; licensed transplant indication, formulation precautions, pregnancy and breastfeeding contraindications, and blood-count monitoring.
SPS mycophenolate mofetil monitoringJanuary 2026 published monitoring intervals; the page notes pending alignment with the November 2025 BSR guideline, so individual specialist and local plans remain essential.