Endocrine Abstracts

Evidence is emerging from the UK and elsewhere that: (a) endocrine clinics are reservoirs of undiagnosed thyroid eye disease (TED); (b) the interval from onset of symptoms of TED to diagnosis and treatment often exceeds 1 year; (c) simple interventions that can be initiated in the endocrine clinic can reverse mild TED and prevent progression; (d) immunosuppressive treatments work best in the first 9 months. Early detection of TED is a fundamental part of management and can be achieved by a simple, easy and rapid clinical evaluation. Management in the endocrine clinic consists of meticulous attention to achieving and maintaining euthyroidism, avoidance of radioiodine, selenium supplements, artificial tears and close monitoring for progression. Patients who progress should be referred to a Joint Thyroid Eye Clinic offering specialist care by a team of experienced endocrinologists and ophthalmologists. Access to Joint Thyroid Eye Clinics should be rapid as there is an inverse relationship between efficacy of medical treatments and duration of TED. High dose intravenous pulses of methylprednisolone are the mainstay of medical treatment for active, moderate to severe TED and for optic nerve compression. Orbital irradiation has a modest beneficial effect in patients with vertical diplopia. Newer medical treatments include biologics, but their role is still under investigation. Surgical management plays an important part in patients with optic nerve compression and more commonly for rehabilitative purposes. Variation in access to surgical services for TED in the UK is high, and an area where improvement is needed. TEAMeD (Thyroid Eye disease AMstErdam Declaration implementation group) was established in 2009 to promote the Amsterdam Declaration, which pledged to improve care for people with TED. ‘TEAMeD-5’, is a campaign to promote better care for patients with TED and provides easily accessible guidance and support for endocrinologists on how to manage TED: http://www.btf-thyroid.org/projects/teamed/332-teamed-5.