TEAMeD-5 - Improving Outcomes in Thyroid Eye Disease
Thyroid eye disease (TED) is a distressing complication of Graves’ disease (GD). TED can have a significant and negative impact upon the quality of patients’ lives and visual function. Delays in making a diagnosis of TED and initiating treatment are common. A recent study has shown that the median time from first symptoms to a diagnosis of TED is 7 months and the median time from first visit to any doctor with symptoms to diagnosis is 2 months. TEAMeD (Thyroid Eye Disease Amsterdam Declaration Implementation Group UK) was established in 2009 to implement the Amsterdam Declaration, which pledged to improve care for people with TED and prevent TED in those at risk.
“TEAMeD-5”, a programme to promote better care for patients with, or at risk of, TED was officially launched at the Society for Endocrinology BES meeting in November 2017.
Click on the text on the poster or scroll down for more details.
1. Diagnose Graves' disease accurately
Key recommendation: TEAMeD recommends that an accurate diagnosis of the cause is made in all cases of thyrotoxicosis to determine the risk or TED; TRAb testing is useful tool in the diagnosis of Graves' disease.
2. Screen all patients with Graves' disease for TED
Key recommendation: TEAMeD recommends a systematic assessment for early signs/symptoms of TED in all patients reviewed in endocrine clinics with an established diagnosis of GD.
- The DiaGO clinical assessment tool is currently under review.
Mitchell AL, Goss L, Mathiopoulou L, Morris M, Vaidya B, Dickinson AJ, Quinn A, Dayan C, McLaren J, Hickey JL, Lazarus JH, Rose GE, Foley P, MacEwen CJ, Perros P. Diagnosis of Graves' orbitopathy (DiaGO): results of a pilot study to assess the utility of an office tool for practicing endocrinologists. J Clin Endocrinol Metab. 2015;100:E458-62. PMID: 25485725
3. Alert all Graves’ patients to the risk of TED
Key recommendation: TEAMeD recommends that all patients with GD are informed about the risk of TED and given an early warning card.
Raising Awareness of Graves' Orbitopathy with Early Warning Cards, A Mitchell et al. Clin Endocrinol (Oxf). 2017 Jul 29. doi: 10.1111/cen.13438. [Epub ahead of print] PubMed: 28755510
4. Prevent TED
Key recommendation: TEAMeD recommends that all patients with GD receiving I-131 are monitored closely and treated early with thyroxine to avoid a period of hypothyroidism. In active TED, I-131 therapy should either be deferred or steroid cover given.
- Encourage smoking cessation
- Achieve and maintain euthyroidism rapidly
- Avoid hypothyroidism after I-131
- Avoid radioactive iodine (I-131) in active TED
5. Refer to a specialist clinic early
Key recommendation: TEAMeD recommends that endocrine teams identify a specialist multidisciplinary thyroid-eye clinic in their region consistent with British OculoPlastic Surgery Society (BOPSS) recommendations and refer all patients with moderate or severe TED or TED affecting the patients’ quality of life to this service. BOPSS is currently working with TEAMeD to develop standards for specialist ophthalmology care for people with thyroid eye disease.
- Mild TED (TED that only has a minor impact on daily life and quality of life)
- Moderate or severe TED or TED affecting quality of life: refer to a specialist multidisciplinary thyroid-eye clinic
About the Thyroid Eye Disease Amsterdam Declaration Implementation Group UK
The original working group established in 2009 - BTF and TEDct - was joined by representatives of professional organisations in 2010: the Royal College of Physicians, the Royal College of Ophthalmologists, the Scottish Ophthalmologists Club, the Society for Endocrinology, the British OculoPlastic Surgery Society, the British Thyroid Association and the British and Irish Orthoptic Society.
The working group adopted the name ‘TEAMeD’ (Thyroid Eye Disease AMsterdam Declaration Implementation Group UK).
Guided by the Amsterdam Declaration, TEAMeD is working to improve the patient experience for people with thyroid eye disease by seeking to put in place measures to ensure patients have access to early diagnosis, appropriate treatment, skilled professionals and high standards of joint care from endocrinologists and ophthalmologists. National - and international - standards are vital to ensure that people with thyroid eye disease can be diagnosed correctly and on time and have access to the best possible treatment in specialist centres.