title: Management of patients in a combined thyroid eye clinic in secondary care.
abstract: The European Group on Graves' Orbitopathy (EUGOGO) recommends the use of specialised multidisciplinary clinics for the management of thyroid eye disease (TED). In the UK, many patients with TED are managed outside of specialised clinics. We describe the organisation of a combined TED clinic in a secondary care setting and present the result of a prospective audit of the patient characteristics and outcomes during the first four years of a combined TED clinic. Of a total of 132 patients referred to the TED clinic, 114 (86 %) had TED (90 females, median age 56 years; range 17-90 years). At presentation, 77 (67 %) were current or ex-smokers and 99 (87 %) were biochemically euthyroid. Median duration of eye symptoms was 12 months. Fifty-two percent, 45 and 3 had mild, moderate-to-severe and sight-threatening TED, respectively. Only 18 % of patients had a clinical activity score (CAS) of ≥3. Sixty-nine patients (61 %) required follow-up appointments in the TED clinic. In those who required follow-up, 43 % (n = 30) received either immunosuppressive or surgical treatment. CAS improved from first to final visit, with 29 % (n = 20) having a CAS of ≥3 at the first visit and 1 % (n = 1) at the final visit (p = 0.0001). There was also a decrease in prevalence of smoking and thyroid dysfunction at the final visit. A multidisciplinary specialised TED clinic offers an optimal setting for managing patients with TED; however, patients are often referred late to a specialist TED clinic.
authors.affiliation: West of England Eye Unit, Royal Devon and Exeter Hospital, Exeter, UK, james_benzimra@hotmail.com.
authors.forename: J D
authors.initials: JD
authors.lastname: Benzimra
authors.forename: A G
authors.initials: AG
authors.lastname: Quinn
authors.forename: T
authors.initials: T
authors.lastname: Kersey
authors.forename: D
authors.initials: D
authors.lastname: McGrane
authors.forename: L
authors.initials: L
authors.lastname: Goss
authors.forename: B
authors.initials: B
authors.lastname: Vaidya
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D054869:Clinical Audit; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D005260:Female; D006111:Graves Disease / Q000628:therapy*; D049970:Graves Ophthalmopathy / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D063728:Secondary Care Centers / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D006113:United Kingdom; D055815:Young Adult
references.citation: Graefes Arch Clin Exp Ophthalmol. 2008 Sep;246(9):1315-21
references.pmid: 18581132
references.citation: Eur J Endocrinol. 2009 Sep;161(3):483-7
references.pmid: 19542244
references.citation: Eur J Endocrinol. 2003 May;148(5):491-5
references.pmid: 12720530
references.citation: Eur J Endocrinol. 2008 Mar;158(3):273-85
references.pmid: 18299459
references.citation: Thyroid. 2010 Mar;20(3):245-6
references.pmid: 20187780
references.citation: Clin Endocrinol (Oxf). 1997 Jul;47(1):9-14
references.pmid: 9302365
references.citation: Clin Endocrinol (Oxf). 2008 Apr;68(4):635-9
references.pmid: 17973942
references.citation: BMJ. 2009 Mar 06;338:b560
references.pmid: 19270020
references.citation: Eur J Endocrinol. 2006 Aug;155(2):207-11
references.pmid: 16868132
references.citation: Nat Clin Pract Endocrinol Metab. 2007 May;3(5):396-404
references.pmid: 17452966
references.citation: Clin Endocrinol (Oxf). 1995 Jan;42(1):45-50
references.pmid: 7889631
references.citation: N Engl J Med. 2009 Mar 5;360(10):994-1001
references.pmid: 19264688
references.citation: Clin Endocrinol (Oxf). 1993 Apr;38(4):367-72
references.pmid: 8319368