Purpose: There is increasing evidence that a multidisciplinary (MDT) approach optimises diagnosis and management in active Thyroid Eye Disease (TED) and is recommended by current TEAMeD-5 guidelines1. Here we aim to describe the clinical and endocrine characteristics of a large cohorts of patients with TED seen in 3 MDT clinics in London.
Methods: A retrospective patient-cohort study of 236 patients with suspected TED referred to these services between 2012 and 2019. Whole group correlations and subgroup analyses were analysed at baseline across several patient factors.
Results: Median patient age was 49.0 years, 77.5% were female, 23.3% Afro-Caribbean. 166 (70.3%) were on treatment for Graves thyrotoxicosis, 25(10.6%) were hypothyroid at first clinic and 29 (12.3%) had normal thyroid function and on no treatment. Of 183 (77.5%) patient who had an autoantibody measurement, 80.5% had positive thyroid-stimulating hormone (TSH) antibody titre, with the median titre being 6.6 IU/l (IQR:2.417.8, normal: <1.75 IU/l). A positive correlation between Clinical Activity Score (CAS) and TSH antibody titre was found (R = 0.30, P <0.05). There were 52/236 (22.0%) current smokers, all of whom received documented smoking cessation advice. 32.5% patients had a positive family history for thyroid disease, however significantly fewer patients with sight-threatening disease had a positive FH than those without (P<0.05). Patients with sight-threatening disease were significantly older than those without (P = 0.0378).
Conclusion: These results suggest that cases of sight-threatening disease were more prevalent in older populations and reported family history was not a predictor of disease activity. TSH R antibody demonstrated a positive correlation CAS but other factors influence the variance seen in CAS. Further biomarkers are warranted in this complex, costly and debilitating disease.