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    Consensus on Treating Thyroid Eye Disease

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    An international team of endocrinologists and ophthalmologists has issued a consensus statement on the evaluation and management of thyroid eye disease (TED).1,2 The statement is intended to serve as a guide for special­ists caring for patients with TED.

    Photographs of a patient's eyes.

    ASYMMETRIC TED. (1A) Right upper eyelid retraction, (1B) left relative exophthalmos, (1C) right upper lid lag with downgaze, and (1D) bilateral lagophthalmos with inferior corneal exposure on the right.

    Support for multidisciplinary approach. The consensus statement emphasizes a multidisciplinary approach to treatment—and it makes the point that ophthalmologists should always be involved in the care of patients with moderate-to-severe TED.

    “Thyroid eye disease requires a combined effort from ophthalmologists and endocrinologists in order to ensure adequate assessment of both thyroid and eye manifestations,” said coauthor Mar­ius N. Stan, MD, at the Mayo Clinic in Rochester, Minnesota.

    Rapidly changing therapeutic arena. The need for a consensus statement was driven, in part, by the introduction of teprotumumab (Tepezza) as well as ongoing investigations into other potential agents for treatment of TED, said Dr. Stan.

    Lessons for ophthalmology. While the statement targets endocrinologists, it holds lessons for ophthalmologists, said Jeremiah Tao, MD, FACS, at the Univer­sity of California, Irvine. These include the following:

    • TED has differing degrees of severity as well as many phenotypes.
    • Smoking cessation can significantly improve the disease course.
    • Although teprotumumab is considered a promising new option, it is not universally efficacious and is associated with hearing loss and high cost. Other treatment options cited include glucocorticoids and other steroid-sparing agents, radiation, and surgery.

    Toward optimal care. Dr. Tao agreed that optimal management of TED is collaborative in nature, spanning many medical disciplines and, within ophthalmology, several subspecialties.

    Dr. Stan added, “It is important to keep in mind that TED can precede thyroid abnormalities and, in 5% of cases, the thyroid manifestations may not be present at all, despite clear changes consistent with TED. Monitoring thyroid parameters will be important in these cases, and that is another aspect where collaboration will offer optimal care for these individuals.”

    —Miriam Karmel

    ___________________________

    1 Burch HB et al. Thyroid. 2022;32(1):1439-1470.

    2 Burch HB et al. Eur Thyroid J. 2022;11(6):e220189.

    ___________________________

    Relevant financial disclosures: Dr. Stan—Horizon Therapeutics: C; Dr. Tao—None.

    For full disclosures and the disclosure key, see below.

    Full Financial Disclosures

    Dr. Basit Engineering and Physical Sciences Research Council: S.

    Dr. Bharti None.

    Dr. Challa Aerie: P; NIH: S.

    Mr. Pollard Engineering and Physical Sciences Research Council: S.

    Dr. Stan Argenx: C; Horizon Therapeutics: C; Immunovant: C; Or­thoDiagnostics: C; OSE Immunotherapeutics: C; Roivant: C; Septerna: C; Sling Therapeutics: C; Third Rock Ven­tures: C; Tourmaline: C.

    Dr. Tao None.

    Disclosure Category

    Code

    Description
    Consultant/Advisor C Consultant fee, paid advisory boards, or fees for attending a meeting.
    Employee E Hired to work for compensation or received a W2 from a company.
    Employee, executive role EE Hired to work in an executive role for compensation or received a W2 from a company.
    Owner of company EO Ownership or controlling interest in a company, other than stock.
    Independent contractor I Contracted work, including contracted research.
    Lecture fees/Speakers bureau L Lecture fees or honoraria, travel fees or reimbursements when speaking at the invitation of a commercial company.
    Patents/Royalty P Beneficiary of patents and/or royalties for intellectual property.
    Equity/Stock/Stock options holder, private corporation PS Equity ownership, stock and/or stock options in privately owned firms, excluding mutual funds.
    Grant support S Grant support or other financial support from all sources, including research support from government agencies (e.g., NIH), foundations, device manufacturers, and\or pharmaceutical companies. Research funding should be disclosed by the principal or named investigator even if your institution receives the grant and manages the funds.
    Stock options, public or private corporation SO Stock options in a public or private company.
    Equity/Stock holder, public corporation US Equity ownership or stock in publicly traded firms, excluding mutual funds (listed on the stock exchange).

     

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