What CAS score indicates active thyroid eye disease?

CAS ≥3/7 = active inflammatory disease (each of 7 items = 1 point: pain at rest, pain on eye movement, lid erythema, lid edema, caruncle edema, conjunctival injection, chemosis); active disease requires anti-inflammatory treatment; inactive disease may proceed to rehabilitative surgery.

What EUGOGO TED severity defines sight-threatening disease?

Sight-threatening TED: dysthyroid optic neuropathy (DON: RAPD, color vision loss, VF defect, disc edema) OR severe corneal exposure with ulceration; requires urgent IV methylprednisolone 500 mg/week ×6 weeks + orbital decompression if no response in 2 weeks.

What is teprotumumab for TED?

Teprotumumab (anti-IGF-1R antibody) approved for active moderate-severe TED (CAS ≥3); reduces proptosis by mean 3 mm and reduces diplopia; 8 infusions over 24 weeks; approved in US (Tepezza); reduces need for orbital decompression surgery.

What smoking cessation benefit exists in TED?

Smoking doubles TED risk and worsens severity; active smokers have significantly worse orbital inflammation response to immunotherapy; smoking cessation at any point improves TED trajectory; cessation counseling is mandatory in TED management.

What thyroid control is required during TED treatment?

Euthyroid state is essential for TED treatment; both hypothyroidism and hyperthyroidism worsen TED activity; radioiodine treatment increases TED risk (especially if subclinical TED pre-existing); antithyroid drugs and total thyroidectomy are preferred treatment routes in active TED.

Thyroid Eye Disease Clinical Activity Score (CAS)

Calculates the Clinical Activity Score (CAS) for thyroid eye disease, EUGOGO severity classification (mild/moderate-severe/sight-threatening), teprotumumab eligibility criteria, and orbital decompression timing.

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