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This case presents the unique challenges of managing severe sight-threatening TED during pregnancy and the multidisciplinary approach needed to carefully balance risks and optimise maternal and fetal outcomes.<\/jats:p>","DOI":"10.1136\/bcr-2025-267100","type":"journal-article","created":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T04:35:20Z","timestamp":1757651720000},"page":"e267100","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Severe refractory TED presenting in pregnancy: vignettes of a multimodal approach"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9039-0238","authenticated-orcid":false,"given":"Johnbosco Emmanuel","family":"Mamah","sequence":"first","affiliation":[{"name":"Obstetrics and Gynaecology, East Suffolk and North Essex NHS Foundation Trust, England, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sonja","family":"Mansfield Smith","sequence":"additional","affiliation":[{"name":"Opthalmology, East Suffolk and North Essex NHS Foundation Trust Ipswich Hospital, Ipswich, England, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruta","family":"Gada","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynaecology, East Suffolk and North Essex NHS Foundation Trust Ipswich Hospital, Ipswich, England, UK"},{"name":"University of Suffolk, Ipswich, England, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sanjeev","family":"Sharma","sequence":"additional","affiliation":[{"name":"East Suffolk and North Essex NHS Foundation Trust Ipswich Hospital, Ipswich, England, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,9,11]]},"reference":[{"key":"2025091121351034000_18.9.e267100.1","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1111\/cen.14296","article-title":"Prevalence of thyroid eye disease in Graves\u2019 disease: A meta-analysis and systematic review","volume":"93","author":"Chin","year":"2020","journal-title":"Clin Endocrinol (Oxf)"},{"key":"2025091121351034000_18.9.e267100.2","doi-asserted-by":"crossref","DOI":"10.1530\/ETJ-22-0189","article-title":"Management of thyroid eye disease: a Consensus Statement by the American Thyroid Association and the European Thyroid Association","volume":"11","author":"Burch","year":"2022","journal-title":"Eur Thyroid J"},{"key":"2025091121351034000_18.9.e267100.3","doi-asserted-by":"crossref","DOI":"10.3390\/jpm14070776","article-title":"Thyroid Eye Disease: Advancements in Orbital and Ocular Pathology Management","volume":"14","author":"Scarabosio","year":"2024","journal-title":"J Pers Med"},{"key":"2025091121351034000_18.9.e267100.4","unstructured":"Shah SS , Patel BC . 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