Introduction: The Oxford multidisciplinary thyroid eye disease (TED) clinic comprising an oculoplastic surgeon, rheumatologist and endocrinologist with access to orthoptics, neuroradiology and radiotherapy was established in 2013. The aim of the service is to facilitate rapid referral and treatment in a specialist centre in keeping with the Amsterdam Declaration. Early use of steroid sparing agents (SSA) and recently rituximab form part of the treatment regimen.
Methods: A retrospective, 4-year, single-centre, consecutive case series of patients with TED audited outcome using the VISA classification and treatment modalities, at presentation and 1 year follow-up.
Results: 111 patient records were analysed. Mean wait from referral to first review was 1 month with 35.1% of referrals originating from endocrinology departments. Mean age was 51.2 years (1084). 25.2% (n=28) of patients were male and 34% were current/ex-smokers. Where thyroid biochemistry was available at referral (n=86): 53% were euthyroid, 43% hyperthyroid and 4% hypothyroid. TSHRAb was positive in 84% of patients checked compared to 62% of TPO Ab. Presenting signs included: ocular surface disease (69%), exophthalmos (53%), diplopia (45%), eyelid retraction (35%) and reduced vision (9%). Presenting activity was mild (VISA ≤3/10) in 60% and severe in 21% (≥7); severity mild in 43% and severe in 22%. 1 year data (n=36) showed mild activity at 1 year in 95% (38.9% at referral) and 0% severe disease (33% at referral). Intravenous methylprednisolone was administered to 33 patients; 42% received ≤1.5 g total with use of SSAs: methotrexate (n=31), azathioprine (n=6), ciclosporin (n=10) and Rituximab (n=9). Orbital decompression surgery was performed in 12.6% (n=14), squint surgery 12%, eyelid surgery 22% and orbital radiotherapy 6%.
Conclusion: Early use of SSAs has significantly reduced the overall steroid load in patients when compared to established European guidance (EUGOGO). This regimen confers a low orbital decompression and orbital radiotherapy rate.