Endocrine Abstracts

Background: Thyroid Eye Disease (TED) is an autoimmune condition affecting the retro-ocular tissues. It is associated with Graves’ disease, and the spectrum of signs and symptoms ranges from mild to sight threatening. Screening, diagnosis, initial management and decision for referral to Ophthalmology are key skills for Endocrinologists in managing patients with Graves’ Disease. Modifiable risk factors for the development of TED include uncontrolled Graves’, cigarette smoking and the use of radioactive iodine. The Endocrine Society suggests the TEAMeD-5 programme to reduce morbidity associated with TED. This includes: 1) Diagnose Graves’ accurately, 2) Screen all patients with Graves’ for TED, 3) Provide an early warning card to highlight symptoms of TED, 4) Prevent TED development by modifying risk factors and 5) Early specialist referral. There is abundant material available to implement this programme.

Method: Using a positive TRAB antibody as a method to identify potential patients with Graves’ disease, a chart review was undertaken to review screening for TED in patients undergoing treatment for Graves’ and to ensure smoking cessation was advised and documented.

Results: Of the 103 charts reviewed, 84 (82%) had documented screening for TED. Methods of screening however were heterogenous, only 3 patients were screened using the validated screening tool the ‘Clinical Activity Score’ (CAS). 79 (77%) of charts had documentation of the smoking status. 33 patients were active smokers or vapers, of these, 88% had a documented discussion on smoking cessation. No patients were given a warning card for TED.

Discussion: Endocrinologists play an important role in the management of Thyroid Eye Disease. This audit has shown our centre performs moderately well in certain aspects of the TEAMeD-5 programme to reduce morbidity with TED, however several of the aspects are not implemented or are sporadically employed. We aim to implement this program fully and re-audit our adherence.