title: Diagnosis of Graves' orbitopathy (DiaGO): results of a pilot study to assess the utility of an office tool for practicing endocrinologists.
abstract: BACKGROUND
  In active Graves' orbitopathy (GO), treatment can improve the final cosmetic and visual outcome. Diagnostic delay results in significant morbidity and increases patient dissatisfaction. However, it can be challenging for endocrinologists to recognize GO and decide who should be referred for ophthalmic care.
  
  
  OBJECTIVE
  DiaGO, a clinical assessment tool, was developed for use in patients with Graves' disease (GD). The tool is designed to alert clinicians to the possibility of GO and prompt early ophthalmic assessment.
  
  
  METHODS
  A 20-point assessment tool was devised and tested on 104 GD patients: 27 "positive controls" with GO and 77 people with GD attending endocrine clinics over 17 months. Those scoring positively in endocrine clinics were referred for ophthalmic assessment. Both the appropriateness of the referral and subsequent treatment were assessed.
  
  
  RESULTS
  Eighty-eight of the 104 patients (85%) were female (mean age, 48.5 y; range, 18-76 y). All 27 "controls" scored positively. Of the 77 people evaluated with GD, 27 (35%) scored above the threshold for referral and GO was confirmed in 24/26 (92%) who attended for specialist ophthalmic assessment. Twelve of these 24 (50%) were offered specific treatment following ophthalmology review.
  
  
  CONCLUSIONS
  The timely diagnosis of GO is important because early intervention in active disease can improve prognosis. DiaGO alerts clinicians to the possibility of GO and prompts referral to specialist ophthalmic care. It is quick and easy to use and does not require specialist ophthalmic skills. Overall, half of those referred after use of DiaGO were offered specific treatment, suggesting its use might significantly improve the management of patients.
authors.affiliation: Multidisciplinary thyroid eye clinic (A.L.M., L.M., M.M., A.J.D., P.P.), Newcastle upon Tyne NHS Hospitals Trust, Newcastle upon Tyne, NE1 4LP United Kingdom; Multidisciplinary Thyroid Eye Clinic (L.G., B.V., A.Q.), Royal Devon and Exeter NHS Foundation Trust, Exeter, EX2 5DW United Kingdom; Institute of Molecular and Experimental Medicine (C.D., J.H.L.), Cardiff University School of Medicine, Cardiff, CF14 4XN United Kingdom; Thyroid Eye Disease Charitable Trust (J.M.), Bristol, BS37 0AX United Kingdom; British Thyroid Foundation (J.L.H., P.F.), Harrogate, HG1 4AA United Kingdom; Moorfields Eye Hospital (G.E.R.), London, EC1V 2PD United Kingdom; Department of Ophthalmology (C.J.M.), Ninewells Hospital, Dundee, DD1 9SY United Kingdom; and Institute of Genetic Medicine (P.P.), Newcastle University, Newcastle upon Tyne, NE1 3BZ United Kingdom.
authors.forename: Anna L
authors.initials: AL
authors.lastname: Mitchell
authors.forename: Linda
authors.initials: L
authors.lastname: Goss
authors.forename: Lemonia
authors.initials: L
authors.lastname: Mathiopoulou
authors.forename: Margaret
authors.initials: M
authors.lastname: Morris
authors.forename: Bijay
authors.initials: B
authors.lastname: Vaidya
authors.forename: A Jane
authors.initials: AJ
authors.lastname: Dickinson
authors.forename: Anthony
authors.initials: A
authors.lastname: Quinn
authors.forename: Colin
authors.initials: C
authors.lastname: Dayan
authors.forename: Julie
authors.initials: J
authors.lastname: McLaren
authors.forename: Janis L
authors.initials: JL
authors.lastname: Hickey
authors.forename: John H
authors.initials: JH
authors.lastname: Lazarus
authors.forename: Geoffrey E
authors.initials: GE
authors.lastname: Rose
authors.forename: Peter
authors.initials: P
authors.lastname: Foley
authors.forename: Caroline J
authors.initials: CJ
authors.lastname: MacEwen
authors.forename: Petros
authors.initials: P
authors.lastname: Perros
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D057189:Checklist; D003940:Diagnostic Techniques, Endocrine; D005260:Female; D049970:Graves Ophthalmopathy / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009819:Office Visits; D010865:Pilot Projects; D011364:Professional Practice; D011795:Surveys and Questionnaires; D055815:Young Adult