{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T12:33:00Z","timestamp":1771504380508,"version":"3.50.1"},"reference-count":37,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Br J Ophthalmol"],"accepted":{"date-parts":[[2025,8,18]]},"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>This study aims to determine factors contributing to the delayed identification and treatment of thyroid eye disease (TED) and ultimately provide recommendations for earlier identification of patients in need of care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Retrospective cross-sectional data from patients in the Iranian TED (IrTED) registry, presented to Rassoul Akram Hospital, Tehran (March 2013\u20132023), were studied. Demographics, clinical indices of activity and severity and factors associated with delayed presentation were examined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 685 patients with TED, the mean diagnosis age was 37.79 years. A positive family history of thyroid dysfunction was reported by 37.66% (first-degree), 10.65% (second-degree) and 10.07% (both). According to the European Group on Graves\u2019 Orbitopathy criteria, 56.49% had moderate-to-severe, 38.10% had mild, and 5.40% had sight-threatening TED. 59 patients were classified as active due to the recent onset of diplopia or proptosis, despite having an activity score of 1 or 2. Men were five times more likely to have active TED than women and 10-fold more likely to have sight-threatening TED. For every one-decade increase in age, the odds of having active TED and experiencing sight-threatening TED rise by approximately 72% and 96%, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Given the potential for targeted interventions such as smoking cessation, identifying high-risk relatives of thyroid dysfunction cases could help minimise disease progression and associated complications (primary prevention). Men and elderly patients are more likely to experience delayed diagnosis, leading to more severe presentations of TED (secondary prevention). Approximately one-fourth of patients had active TED, requiring anti-inflammatory treatment. However, the Clinical Activity Score threshold of 3 did not detect 34.91% of these active cases (tertiary prevention).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bjo-2025-327392","type":"journal-article","created":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T17:20:12Z","timestamp":1757697612000},"page":"256-261","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Call for timely prevention in thyroid eye disease: lessons from the IrTED registry"],"prefix":"10.1136","volume":"110","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2045-6163","authenticated-orcid":false,"given":"Nasser","family":"Karimi","sequence":"first","affiliation":[{"name":"Eye Research Center, Department of Ophthalmology, The Five Senses Health Institute, Moheb Kowsar Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2623-3034","authenticated-orcid":false,"given":"Shadi","family":"Akbarian","sequence":"additional","affiliation":[{"name":"Eye Research Center, Department of Ophthalmology, The Five Senses Health Institute, Moheb Kowsar Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6498-1408","authenticated-orcid":false,"given":"Hossein","family":"Ghahvehchian","sequence":"additional","affiliation":[{"name":"Eye Research Center, Department of Ophthalmology, The Five Senses Health Institute, Moheb Kowsar Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-9016-9614","authenticated-orcid":false,"given":"Bahareh","family":"Kermani","sequence":"additional","affiliation":[{"name":"Eye Research Center, Department of Ophthalmology, The Five Senses Health Institute, Moheb Kowsar Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0030-7793","authenticated-orcid":false,"given":"Atefeh","family":"Mahdian Rad","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Faculty of Medicine, Infectious Ophthalmic Research Center, Ahvaz Jondishapour University of Medical Sciences, Ahvaz, Iran (the Islamic Republic of)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0347-5549","authenticated-orcid":false,"given":"Mohsen Bahmani","family":"Kashkouli","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology and Visual Sciences, University of Louisville School of Medicine, Louisville, Kentucky, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,9,12]]},"reference":[{"key":"2026021903500787000_110.3.256.1","doi-asserted-by":"publisher","DOI":"10.1089\/105072502761016476"},{"key":"2026021903500787000_110.3.256.2","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1186\/s13643-020-01459-7","article-title":"Prevalence of hyperthyroidism, hypothyroidism, and euthyroidism in thyroid eye disease: a systematic review of the literature","volume":"9","author":"Mu\u00f1oz-Ortiz","year":"2020","journal-title":"Syst Rev"},{"key":"2026021903500787000_110.3.256.3","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1097\/IIO.0000000000000464","article-title":"Pathogenesis of Thyroid Eye Disease","volume":"63","author":"Spadaro","year":"2023","journal-title":"Int Ophthalmol Clin"},{"key":"2026021903500787000_110.3.256.4","doi-asserted-by":"crossref","first-page":"16","DOI":"10.4103\/joco.joco_266_21","article-title":"A Systematic Review on the Role of Antioxidants in Thyroid Eye Disease","volume":"34","author":"Akbarian","year":"2022","journal-title":"J Curr Ophthalmol"},{"key":"2026021903500787000_110.3.256.5","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1080\/09286586.2016.1255974","article-title":"Measurement Properties of the Persian Translated Version of Graves Orbitopathy Quality of Life Questionnaire: A Validation Study","volume":"24","author":"Kashkouli","year":"2017","journal-title":"Ophthalmic Epidemiol"},{"key":"2026021903500787000_110.3.256.6","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2265.1997.2331047.x"},{"key":"2026021903500787000_110.3.256.7","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1186\/s13023-024-03053-9","article-title":"Implementation of thyroid eye disease registry in Iran: rationale and research protocol","volume":"19","author":"Akbarian","year":"2024","journal-title":"Orphanet J Rare Dis"},{"key":"2026021903500787000_110.3.256.8","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1080\/08820538.2025.2463946","article-title":"Iran Thyroid Eye Disease (IrTED) Registry: Patient Characteristics and Clinical Presentation","volume":"40","author":"Akbarian","year":"2025","journal-title":"Semin Ophthalmol"},{"key":"2026021903500787000_110.3.256.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2007.11.008"},{"key":"2026021903500787000_110.3.256.10","doi-asserted-by":"publisher","DOI":"10.1530\/acta.0.1280156"},{"key":"2026021903500787000_110.3.256.11","first-page":"612","article-title":"Thyroid-associated ophthalmopathy in Iranian patients","volume":"49","author":"Kashkouli","year":"2011","journal-title":"Acta Med Iran"},{"key":"2026021903500787000_110.3.256.12","doi-asserted-by":"publisher","DOI":"10.1097\/IJG.0b013e31802e644b"},{"key":"2026021903500787000_110.3.256.13","doi-asserted-by":"publisher","DOI":"10.4103\/joco.joco_223_21"},{"key":"2026021903500787000_110.3.256.14","doi-asserted-by":"publisher","DOI":"10.1530\/eje.0.1480491"},{"key":"2026021903500787000_110.3.256.15","doi-asserted-by":"publisher","DOI":"10.1136\/bjophthalmol-2015-306733"},{"key":"2026021903500787000_110.3.256.16","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1001\/jamaophthalmol.2022.1002","article-title":"Nationwide Incidence of Thyroid Eye Disease and Cumulative Incidence of Strabismus and Surgical Interventions in Denmark","volume":"140","author":"Boulakh","year":"2022","journal-title":"JAMA Ophthalmol"},{"key":"2026021903500787000_110.3.256.17","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajo.2023.04.013"},{"key":"2026021903500787000_110.3.256.18","doi-asserted-by":"publisher","DOI":"10.1136\/bjophthalmol-2014-305649"},{"key":"2026021903500787000_110.3.256.19","doi-asserted-by":"crossref","DOI":"10.1210\/jendso\/bvad148","article-title":"Prevalence, Incidence, and Clinical Characteristics of Thyroid Eye Disease in Japan","volume":"8","author":"Watanabe","year":"2023","journal-title":"J Endocr Soc"},{"key":"2026021903500787000_110.3.256.20","first-page":"105","article-title":"Positive TgAbs in patients with Graves\u2019 orbitopathy are associated with lower risk of its active form - preliminary study","volume":"40","author":"Wojciechowska-Durczynska","year":"2019","journal-title":"Neuro Endocrinol Lett"},{"key":"2026021903500787000_110.3.256.21","doi-asserted-by":"crossref","first-page":"2335","DOI":"10.4103\/ijo.IJO_3217_21","article-title":"Update on thyroid eye disease: Regional variations in prevalence, diagnosis, and management","volume":"70","author":"Yu","year":"2022","journal-title":"Indian J ophthalmol"},{"key":"2026021903500787000_110.3.256.22","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2265.1996.8220832.x"},{"key":"2026021903500787000_110.3.256.23","doi-asserted-by":"crossref","first-page":"1442","DOI":"10.1038\/eye.2011.186","article-title":"Hyperthyroid vs hypothyroid eye disease: the same severity and activity","volume":"25","author":"Kashkouli","year":"2011","journal-title":"Eye (Lond)"},{"key":"2026021903500787000_110.3.256.24","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1016\/j.joco.2018.07.001","article-title":"The epidemiological characteristics of patients with thyroid eye disease in a referral center in northern Iran","volume":"30","author":"Medghalchi","year":"2018","journal-title":"J Curr Ophthalmol"},{"key":"2026021903500787000_110.3.256.25","doi-asserted-by":"crossref","first-page":"1629","DOI":"10.4103\/ijo.IJO_104_20","article-title":"Clinical profile of thyroid eye disease and factors predictive of disease severity","volume":"68","author":"Muralidhar","year":"2020","journal-title":"Indian J Ophthalmol"},{"key":"2026021903500787000_110.3.256.26","doi-asserted-by":"crossref","first-page":"183","DOI":"10.4103\/meajo.MEAJO_91_17","article-title":"Epidemiology and Clinical Features of Thyroid-associated Orbitopathy in Accra","volume":"24","author":"Ackuaku-Dogbe","year":"2017","journal-title":"Middle East Afr J Ophthalmol"},{"key":"2026021903500787000_110.3.256.27","first-page":"99","article-title":"Prevalence of Graves\u2019 ophthalmopathy in patients with Graves\u2019 disease presenting to a referral centre in north India","volume":"139","author":"Reddy","year":"2014","journal-title":"Indian J Med Res"},{"key":"2026021903500787000_110.3.256.28","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2012-3873"},{"key":"2026021903500787000_110.3.256.29","first-page":"36","article-title":"Management of exophthalmos and related ocular changes in Graves\u2019 disease","volume":"6","author":"RUNDLE","year":"1957","journal-title":"Metab Clin Exp"},{"key":"2026021903500787000_110.3.256.30","doi-asserted-by":"publisher","DOI":"10.1136\/bjo-2024-325346"},{"key":"2026021903500787000_110.3.256.31","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1097\/IOP.0000000000001942","article-title":"The \u201cQuiet TED\u201d-A Special Subgroup of Thyroid Eye Disease","volume":"37","author":"I\u00f1iguez-Ariza","year":"2021","journal-title":"Ophthalmic Plast Reconstr Surg"},{"key":"2026021903500787000_110.3.256.32","doi-asserted-by":"publisher","DOI":"10.1097\/IOP.0000000000002467"},{"key":"2026021903500787000_110.3.256.33","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1089\/thy.2005.15.146","article-title":"Volume changes in intra- and extraorbital compartments in patients with Graves\u2019 ophthalmopathy: effect of smoking","volume":"15","author":"Szucs-Farkas","year":"2005","journal-title":"Thyroid"},{"key":"2026021903500787000_110.3.256.34","doi-asserted-by":"publisher","DOI":"10.1136\/bjo.87.6.773"},{"key":"2026021903500787000_110.3.256.35","doi-asserted-by":"publisher","DOI":"10.1016\/j.numecd.2015.01.003"},{"key":"2026021903500787000_110.3.256.36","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1089\/thy.2017.0430","article-title":"High Serum Cholesterol Is a Novel Risk Factor for Graves\u2019 Orbitopathy: Results of a Cross-Sectional Study","volume":"28","author":"Sabini","year":"2018","journal-title":"Thyroid"},{"key":"2026021903500787000_110.3.256.37","doi-asserted-by":"crossref","first-page":"1325","DOI":"10.1210\/clinem\/dgab070","article-title":"Statins Decrease the Risk of Orbitopathy in Newly Diagnosed Patients with Graves Disease","volume":"106","author":"Nilsson","year":"2021","journal-title":"J Clin Endocrinol Metab"}],"container-title":["British Journal of Ophthalmology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bjo-2025-327392","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T11:51:10Z","timestamp":1771501870000},"score":1,"resource":{"primary":{"URL":"https:\/\/bjo.bmj.com\/lookup\/doi\/10.1136\/bjo-2025-327392"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,12]]},"references-count":37,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,2,19]]},"published-print":{"date-parts":[[2026,3]]}},"alternative-id":["10.1136\/bjo-2025-327392"],"URL":"https:\/\/doi.org\/10.1136\/bjo-2025-327392","relation":{},"ISSN":["0007-1161","1468-2079"],"issn-type":[{"value":"0007-1161","type":"print"},{"value":"1468-2079","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,12]]}}}