CONCLUSIONS

A significant proportion of patients with thyroid eye dis-ease improve spontaneously as long as euthyroidism is maintained. An initial period of 3 to 6 months of obser-vation with careful serial ophthalmological assessment usu-ally reveals the underlying trend (progression, stability, or deterioration) and is helpful in the long-term management of patients. Progression of the disease indicates a need for therapeutic intervention. The natural tendency toward im-provement in most patients with TED (and deterioration in some) has important implications in the design of clinical studies, which should ideally include a matched con-trol group.