New clinical guidelines for Thyroid Eye Disease

01 August 2015

It is estimated that there are about 2,500 new cases of TED every year in the UK. The figures probably have declined over the past 10–20 years for reasons that are unclear. Nonetheless far too often TED is undiagnosed for several months, or misdiagnosed as allergy or conjunctivitis adding to the frustration of patients and denying them treatments that can make a difference.

Simple, safe and low cost interventions early on can make a big difference. Selenium supplements, lubricant eye drops, prisms, meticulous attention to controlling the thyroid, avoidance of radioactive iodine and smoking cessation, can prevent deterioration of the eye disease and improve quality of life.

In 2009 the European Group On Graves’ Orbitopathy (EUGOGO) spearheaded an international drive to improve the care of patients with TED. The Amsterdam Declaration for people with TED was signed by 84 national and international professional and patient-led organisations including the TEDct, pledging to improve patient care.

In the UK TEAMeD was born (Thyroid Eye Disease Amsterdam Declaration Implementation Group, aiming to implement these objectives in the UK. In particular diagnosing TED early and getting patients to be seen in specialist centres was a high priority. And one way of achieving this is clinical guidelines. TEAMeD embarked on this project three years ago and was able to secure support by the Royal College of Physicians as part of the College’s “Concise Guidance” series. After extensive deliberations between experts in endocrinology and ophthalmology and expert patients the guidelines1 were published in April 2015.

These guidelines focus on four key areas:

  1. criteria for early diagnosis of TED by GPs and endocrinologists
  2. initiating simple, effective treatments as soon as the diagnosis is made
  3. guidance on which patients should be referred to specialist centres, and
  4. empowering patients with Graves’ disease to recognise the early symptoms of TED.

It is hoped that the guidelines will facilitate early diagnosis and better treatment of patients with this disfiguring disease.

The full text of the guidelines is available from the Royal College of Physicians at:

1 – Perros P, Dayan CM, Dickinson AJ, Ezra D, Estcourt S, Foley P, Hickey J, Lazarus JH, MacEwen CJ, McLaren J, Rose GE, Uddin J, Vaidya B. Management of patients with Graves’ orbitopathy: initial assessment, management outside specialised centres and referral pathways. Clin Med. 2015;15:173–8.