Ethnic and Racial Variations in Thyroid Eye Disease: Clinical Features and Management

Background: Thyroid eye disease (TED) is an autoimmune orbital disorder with a broad clinical spectrum, ranging from mild symptoms to sight-threatening complications. Increasing evidence demonstrates variation in disease presentation and severity across populations, with implications for diagnosis and management. Methods: This narrative review synthesizes published literature from PubMed, Web of Science, MEDLINE (via EBSCOhost and Ovid), and the Cochrane Library to examine ethnic and racial differences in the epidemiology, orbital anatomy, clinical phenotype, immunologic profile, diagnosis, and management of TED across diverse populations. Results: Female predominance is highest in African and Western populations and lower in Asian cohorts, while thyroid status varies most in South Asia. Smoking rates are higher in Western populations and lower in South Asian and African cohorts. Asian populations more commonly exhibit muscle-predominant disease with increased risk of apical crowding, whereas Western populations more frequently present with prominent proptosis and eyelid signs; South Asian and Middle Eastern populations show more variable patterns. Inflammatory activity is often low at presentation, although a “low-CAS progressive” phenotype has been described in Asian cohorts. TRAb positivity is consistently high across populations, but is highest in South Asian cohorts. Diagnostic interpretation is influenced by population-specific anatomic differences and limitations of standard assessment tools. Management varies by region, with greater reliance on antithyroid medications in Asian and African populations and wider access to advanced therapies in Western settings. Conclusion: Ethnic differences in TED have important clinical implications. Population-specific interpretation of clinical findings is essential, as standard assessment tools may not fully reflect disease severity.