In primary care, the management of moderate to severe Graves' ophthalmopathy primarily involves initial assessment of hyperthyroidism and appropriate referral to specialist services, as definitive management falls within secondary care NICE NG145.
For adults with Graves' disease, it is important to be aware that active thyroid eye disease, which would include moderate to severe ophthalmopathy, makes radioactive iodine unsuitable as a first-line definitive treatment NICE NG145. This consideration is crucial when discussing treatment options or referring patients NICE NG145.
While awaiting specialist assessment and further treatment, antithyroid drugs, such as carbimazole, can be considered along with supportive treatment for adults with hyperthyroidism NICE NG145. It is important to note that the use of carbimazole is subject to MHRA advice regarding contraception and the risk of acute pancreatitis NICE NG145.
The presence of thyroid eye disease complicates the treatment of hyperthyroidism in Graves' disease, highlighting the need for careful and specialized management (Bartalena & Smith 2025). Therefore, patients with moderate to severe Graves' ophthalmopathy require prompt referral to specialist care for comprehensive assessment and management of both the ophthalmopathy and the underlying Graves' disease NICE NG145.