Table 2. Treatment of acute (active) thyroid eye disease.

1. Establish a euthyroid state

2. Cessation of smoking.

3.Consider oral nonsteroidal antiinflammatory agents (NSAIDs) and selenium in mild disease.

4. Immunosupression (oral or parenteral corticosteroid, steroid sparing agents, biologics)

5. Adjunctive low-dose external beam orbital radiotherapy.

6. Consider early orbital decompression where orbital functions are jeopardised despite medical treatment (ie, where there is significant orbital congestion (with 'hydraulic' signs), uncontrolled intraocular pressure, or optic neuropathy).