 1. Total eye score NOSPECS severity score 1 Total eye score is used to assess the severity of TED, which was calculated by multiplying each class of the NOSPECS system1 except class 0 to its grade of severity 0-3, yielding a maximum total score of 63 and a minimum total score of 0 the higher the number the worse the severity The overall ophthalmic outcome is a composite score based on multiple items Soft tissue, retraction, proptosis, diplopia, and corneal involvement; the use of a composite score circumvents the problem arising from the presence of improvement in one item and simultaneous worsening in another item. 