Endocrine Abstracts

Context: Thyroid eye disease is disabling and disfiguring and has a substantial negative impact on quality of life. Medical therapies to reduce inflammation are widely used, but there is limited data from clinical trials beyond 6 months of follow-up.

Methods: 3 year follow-up of a subset of the CIRTED trial (n = 68) which randomized patients to receive high-dose oral steroid with azathioprine/placebo and radiotherapy/sham radiotherapy. We compared baseline severity scores and changes in clinical assessments (including CAS, Ophthalmopathy Index and Total eye score) over the first year to 3 year outcomes including quality of life (GOQOL visual function and visual appearance) and need for surgical intervention.

Results: CAS, Ophthalmopathy Index and total eye score improved over 3 years (P < 0.001). 24/64 individuals (37.5%) with surgical outcome data required surgical intervention. Quality of life at 3 years remained poor, 25% of patients had a GOQOL-Visual Function of 75 or lower and 54.2% had a GOQOL-Visual Acuity of 75 or lower. Over 3 years CAS fell to 0 or 1. Ophthalmopathy Index fell from 9.45 to 6.02, thyroid eye score fell from 14.9 to 6.33. Disease duration of greater than 6 months before treatment was associated with increased need for surgery OR=16.8 (95%CI 2.95, 95.0)P = 0.001. Baseline levels of CAS, Ophthalmopathy Index and total eye score were associated with requiring surgery, although early improvement in CAS was not associated with a reduced need for surgery.

Conclusion: In this first long-term follow-up from a clinical trial of thyroid eye disease, 3 year outcomes remained suboptimal with ongoing poor quality of life and high numbers requiring surgery. Importantly, reduction in CAS to low levels in the first year, a commonly used surrogate outcome measure, was not associated with improved long-term outcomes. Further studies are required to determine if early intervention results in improved outcomes.