title: A questionnaire survey on the management of Graves' orbitopathy in Europe.
abstract: OBJECTIVE
  To determine management patterns among clinicians who treat patients with Graves' orbitopathy (GO) in Europe.
  
  
  METHODS
  Questionnaire survey including a case scenario of members of professional organisations representing endocrinologists, ophthalmologists and nuclear medicine physicians.
  
  
  RESULTS
  A multidisciplinary approach to manage GO was valued by 96.3% of responders, although 31.5% did not participate or refer to a multidisciplinary team and 21.5% of patients with GO treated by responders were not managed in a multidisciplinary setting. Access to surgery for sight-threatening GO was available only within weeks or months according to 59.5% of responders. Reluctance to refer urgently to an ophthalmologist was noted by 32.7% of responders despite the presence of suspected optic neuropathy. The use of steroids was not influenced by the age of the patient, but fewer responders chose to use steroids in a diabetic patient (72.1 vs 90.5%, P<0.001). Development of cushingoid features resulted in a reduction in steroid use (90.5 vs 36.5%, P<0.001) and increase in the use of orbital irradiation (from 23.8% to 40.4%, P<0.05) and surgical decompression (from 20.9 to 52.9%, P<0.001). More ophthalmologists chose surgical decompression for patients with threatened vision due to optic neuropathy, who were intolerant to steroids than other specialists (70.3 vs 41.8%, P<0.01).
  
  
  CONCLUSIONS
  Deficiencies in the management of patients with GO in Europe were identified by this survey. Further training of clinicians, easier access of patients to specialist multidisciplinary centres and the publication of practice guidelines may help improve the management of this condition in Europe.
authors.affiliation: Department of Endocrinology, Freeman Hospital, Newcastle upon Tyne, UK, and Department of Ophthalmology, Orbital Center, Academic Medical Center, Amsterdam, The Netherlands. petros.perros@ncl.ac.uk
authors.forename: P
authors.initials: P
authors.lastname: Perros
authors.forename: L
authors.initials: L
authors.lastname: Baldeschi
authors.forename: K
authors.initials: K
authors.lastname: Boboridis
authors.forename: A J
authors.initials: AJ
authors.lastname: Dickinson
authors.forename: A
authors.initials: A
authors.lastname: Hullo
authors.forename: G J
authors.initials: GJ
authors.lastname: Kahaly
authors.forename: P
authors.initials: P
authors.lastname: Kendall-Taylor
authors.forename: G E
authors.initials: GE
authors.lastname: Krassas
authors.forename: C M
authors.initials: CM
authors.lastname: Lane
authors.forename: J H
authors.initials: JH
authors.lastname: Lazarus
authors.forename: C
authors.initials: C
authors.lastname: Marcocci
authors.forename: M
authors.initials: M
authors.lastname: Marino
authors.forename: M P
authors.initials: MP
authors.lastname: Mourits
authors.forename: M
authors.initials: M
authors.lastname: Nardi
authors.forename: J
authors.initials: J
authors.lastname: Orgiazzi
authors.forename: A
authors.initials: A
authors.lastname: Pinchera
authors.forename: S
authors.initials: S
authors.lastname: Pitz
authors.forename: M F
authors.initials: MF
authors.lastname: Prummel
authors.forename: W M
authors.initials: WM
authors.lastname: Wiersinga
mesh_terms: D019299:Decompression, Surgical; D004704:Endocrinology / Q000706:statistics & numerical data*; D005060:Europe; D049970:Graves Ophthalmopathy / Q000175:diagnosis / Q000601:surgery* / Q000628:therapy*; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D009915:Orbit; D010348:Patient Care Team / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D012017:Referral and Consultation / Q000706:statistics & numerical data; D013256:Steroids / Q000627:therapeutic use; D011795:Surveys and Questionnaires; D013965:Thyroidectomy / Q000706:statistics & numerical data
chemical_list: D007457:Iodine Radioisotopes; D013256:Steroids