title: Management of thyroid eye disease in the United Kingdom: A multi-centre thyroid eye disease audit.
abstract: This article aims to provide baseline data and highlight any major deficiencies in the current level of care provided for adult patients with thyroid eye disease (TED). We undertook a prospective, nonrandomized cross-sectional multicenter observational study. During a 3-month period June-August 2014, consecutive adult patients with TED who presented to nominated specialist eye clinics in the United Kingdom, completed a standardized questionnaire. Main outcome measures were: demographics, time from diagnosis to referral to tertiary centre, time from referral to review in specialist eye clinic, management of thyroid dysfunction, radioiodine and provision of steroid prophylaxis, smoking, and TED classification. 91 patients (mean age 47.88 years) were included. Female-to-male ratio was 6:1. Mean time since first symptoms of TED = 27.92 (73.71) months; from first visit to any doctor with symptoms to diagnosis = 9.37 (26.03) months; from hyperthyroidism diagnosis to euthyroidism 12.45 (16.81) months. First, 13% had received radioiodine. All those with active TED received prophylactic steroids. Seven patients who received radioiodine and did not have TED at the time went on to develop it. Then, 60% patients were current or ex-smokers. 63% current smokers had been offered smoking cessation advice. 65% patients had active TED; 4% had sight-threatening TED. A large proportion of patients (54%) were unaware of their thyroid status. Not enough patients are being provided with smoking cessation advice and information on the impact of smoking on TED and control of thyroid function.
authors.affiliation: a Moorfields Eye Hospital , London , United Kingdom.
authors.forename: F E
authors.initials: FE
authors.lastname: Mellington
authors.affiliation: b Institute of Molecular and Experimental Medicine , Cardiff University School of Medicine , Cardiff , United Kingdom.
authors.forename: C M
authors.initials: CM
authors.lastname: Dayan
authors.affiliation: c Newcastle Eye Centre , Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle upon Tyne , United Kingdom.
authors.forename: A J
authors.initials: AJ
authors.lastname: Dickinson
authors.affiliation: d British Thyroid Foundation , Harrogate , United Kingdom.
authors.forename: J L
authors.initials: JL
authors.lastname: Hickey
authors.affiliation: e Department of Ophthalmology , Ninewells Hospital , Dundee , United Kingdom.
authors.forename: C J
authors.initials: CJ
authors.lastname: MacEwen
authors.affiliation: f Thyroid Eye Disease Charitable Trust , Bristol , United Kingdom.
authors.forename: J
authors.initials: J
authors.lastname: McLaren
authors.affiliation: c Newcastle Eye Centre , Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle upon Tyne , United Kingdom.
authors.forename: P
authors.initials: P
authors.lastname: Perros
authors.affiliation: a Moorfields Eye Hospital , London , United Kingdom.|g UCL Institute of Ophthalmology Biomedical Research Centre for Ophthalmology , London , United Kingdom.
authors.forename: G E
authors.initials: GE
authors.lastname: Rose
authors.affiliation: a Moorfields Eye Hospital , London , United Kingdom.|g UCL Institute of Ophthalmology Biomedical Research Centre for Ophthalmology , London , United Kingdom.
authors.forename: J
authors.initials: J
authors.lastname: Uddin
authors.affiliation: h Department of Endocrinology , Royal Devon and Exeter Hospital and University of Exeter Medical School , Exeter , United Kingdom.
authors.forename: B
authors.initials: B
authors.lastname: Vaidya
authors.affiliation: i Members of TEAMeD and organisations represented: A. J. Dickinson, J. L. Hickey, G. E. Rose and P. Foley - British Thyroid Foundation, J. McLaren and C. M. Dayan - Thyroid Eye Disease Charitable Trust, D. G. Ezra - Royal College of Ophthalmologists, J. Uddin - British Oculoplastic Surgery Society, C. J. MacEwen - Scottish Ophthalmologists Club, J. H. Lazarus - Royal College of Physicians, P. Perros - Society for Endocrinology and B. Vaidya - British Thyroid Association.
authors.forename: P
authors.initials: P
authors.lastname: Foley
authors.affiliation: i Members of TEAMeD and organisations represented: A. J. Dickinson, J. L. Hickey, G. E. Rose and P. Foley - British Thyroid Foundation, J. McLaren and C. M. Dayan - Thyroid Eye Disease Charitable Trust, D. G. Ezra - Royal College of Ophthalmologists, J. Uddin - British Oculoplastic Surgery Society, C. J. MacEwen - Scottish Ophthalmologists Club, J. H. Lazarus - Royal College of Physicians, P. Perros - Society for Endocrinology and B. Vaidya - British Thyroid Association.
authors.forename: J H
authors.initials: JH
authors.lastname: Lazarus
authors.affiliation: i Members of TEAMeD and organisations represented: A. J. Dickinson, J. L. Hickey, G. E. Rose and P. Foley - British Thyroid Foundation, J. McLaren and C. M. Dayan - Thyroid Eye Disease Charitable Trust, D. G. Ezra - Royal College of Ophthalmologists, J. Uddin - British Oculoplastic Surgery Society, C. J. MacEwen - Scottish Ophthalmologists Club, J. H. Lazarus - Royal College of Physicians, P. Perros - Society for Endocrinology and B. Vaidya - British Thyroid Association.
authors.forename: A
authors.initials: A
authors.lastname: Mitchell
authors.affiliation: a Moorfields Eye Hospital , London , United Kingdom.|g UCL Institute of Ophthalmology Biomedical Research Centre for Ophthalmology , London , United Kingdom.
authors.forename: D G
authors.initials: DG
authors.lastname: Ezra
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D049970:Graves Ophthalmopathy / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007457:Iodine Radioisotopes / Q000008:administration & dosage; D008297:Male; D008330:Management Audit; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D006113:United Kingdom; D055815:Young Adult
chemical_list: D005938:Glucocorticoids; D007457:Iodine Radioisotopes
keywords: Amsterdam declaration; Thyroid eye disease; radioiodine; smoking; thyroid function