Clinical Spectrum of Thyroid Eye Disease in a Tertiary Referral Centre in Eastern India: A Case Series

Thyroid eye disease (TED) is a chronic autoimmune inflammatory disorder characterized by a wide spectrum of clinical manifestations ranging from mild features such as eyelid retraction and periorbital edema to vision-threatening complications like compressive optic neuropathy.The purpose of this case series is to highlight the clinical challenges, therapeutic dilemmas, and management complexities encountered in patients with TED.This case series includes five patients diagnosed with thyroid-associated orbitopathy.Four of five patients presented with proptosis, four had restrictive extraocular myopathy, one presented with isolated upper eyelid retraction, and four had elevated intraocular pressure.Three patients required intravenous methylprednisolone therapy for active disease, whereas two were managed conservatively with ocular lubricants and topical antiglaucoma medications.Disease activity was assessed using the Clinical Activity Score (CAS).Intravenous methylprednisolone was administered in indicated cases if disease was found to be active, moderate to severe, and sight-threatening, as per the European Group on Graves' Orbitopathy (EUGOGO) regimen.Post-treatment, patients demonstrated improvement in visual acuity, reduction in proptosis, and decreased eyelid edema.However, residual ocular deviation and extraocular motility restriction persisted, with minimal improvement.All patients underwent regular three-monthly follow-up for monitoring and rehabilitation.We found that systemic corticosteroid therapy was effective in controlling inflammatory activity and improving vision.However, restrictive myopathy and strabismus showed limited reversibility, indicating progression to the fibrotic phase in some cases.Thus, this case series underscores the chronic and potentially progressive nature of TED and highlights the need for a multidisciplinary, individualized treatment approach.Early recognition and timely intervention are critical in preventing irreversible vision loss.The persistence of functional and cosmetic sequelae necessitates longterm follow-up and, in many cases, staged reconstructive surgeries, thereby contributing to the overall social and psychological burden of the disease.