Changing trend in referral to secondary care specialist thyroid eye disease clinic following the Amsterdam declaration.
BACKGROUND
Early diagnosis and treatment of thyroid eye disease (TED) improves outcomes. Previous studies have highlighted delays in diagnosis and referral to specialist centres. The Amsterdam declaration (2009) aimed to halve the time from presentation to diagnosis and from diagnosis to referral to a specialist centre in five years. A recent study from the European group on Graves' orbitopathy tertiary centres showed a trend for earlier referral of patients to the centres. It is unknown whether similar improvements are occurring in secondary care hospitals in the UK.


OBJECTIVE
To study the trend in referral to a UK secondary care specialist TED clinic since the Amsterdam declaration.


METHODS
We carried out a prospective audit of patients who attended the specialist TED clinic after the Amsterdam declaration (2010-2015). We compared their clinical characteristics, including duration of symptoms, disease activity and severity, with those of the patients (n = 114) from an earlier audit attending the clinic during 2004-2008.


RESULTS
During 2010-2015, 126 patients with TED (97 females, median age 55 years, 39 current smokers) attended the clinic. The median time from onset of symptoms to being seen in the clinic was 5 months, reduced from 12 months in 2004-2008 (p < 0.001). As compared to the 2004-2008 cohort, significantly more patients in the current cohort presented with mild disease (72 vs. 52%, p = 0.002). Twenty-seven per cent patients had active TED (clinical activity score ≥3/7) compared to 18% in 2004-2008 (p = 0.1).


CONCLUSIONS
The trend in referral to secondary care specialist TED clinic is changing in line with the Amsterdam declaration aims.
West of England Eye Unit, Department of Ophthalmology, Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, EX2 5DW, UK. annikaquinn@nhs.net.
Annika S
http://orcid.org/0000-0001-9161-7812
AS
Quinn
West of England Eye Unit, Department of Ophthalmology, Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, EX2 5DW, UK.
Leticia R
LR
Dujardin
NIHR Exeter Clinical Research Facility, University of Exeter Medical School, University of Exeter, Exeter, UK.
Bridget
B
Knight
West of England Eye Unit, Department of Ophthalmology, Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, EX2 5DW, UK.
James
J
Benzimra
West of England Eye Unit, Department of Ophthalmology, Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, EX2 5DW, UK.
Anthony G
AG
Quinn
Department of Endocrinology, Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, UK.|University of Exeter Medical School, Exeter, UK.
Bijay
B
Vaidya
D000328:Adult; D054869:Clinical Audit; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D005260:Female; D005500:Follow-Up Studies; D049970:Graves Ophthalmopathy / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D012017:Referral and Consultation / Q000639:trends*; D063127:Secondary Health Care; D063728:Secondary Care Centers; D012955:Societies, Medical; D013997:Time Factors; D006113:United Kingdom; D000078329:Workforce
Amsterdam declaration; Graves’ disease; Joint thyroid eye clinic; Ophthalmopathy; Thyroid