Key achievements

• Patient questionnaire: provided information on referral delays, percentages of patients seen in joint clinics, use of radioiodine, awareness of smoking risks and advice given, treatment received.
• Diagnostic tool Identified previously undiagnosed patients with TED in Endocrine Clinics with 92% accuracy: Mitchell AL et al. 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. DiaGO results
• Specialist Centre questionnaire More than 30 centres in the UK treat moderate / severe TED and around 38% have clinics conducted jointly by an ophthalmologist and an endocrinologist
• Web-based Smoking Tool Advice on the risks of smoking designed specifically for patients with TED
• Orbital decompression Analysis of data in England identified a 30-fold variance in the rates of orbital decompression performed per unit population, by geographical area: Perros P et al. Orbital decompression for Graves' orbitopathy in England. Eye (Lond). 2012 26: 434-7.
• Thyroid Eye Disease Early Warning Card Designed information card and organised small-scale trial in Endocrine Departments in England/Wales
• TED two-day event for Patients, Public and Professionals, Newcastle, May 2014 Discussion of research priorities: Perros P et al. Future research in Graves' orbitopathy: from priority setting to trial design through patient and public involvement. Thyroid 2015: Future Research in Graves' Orbitopathy  See also Newcastle Thyroid Eye Disease Meeting.
• Discussions with CRG in England about commissioning services for TED Recommendations for a patient pathway
• Post-radioactive iodine Graves' management study (PRAGMA) Data analysis of 144 patients with existing TED pre-treatment showed post-treatment worsening of TED in almost 3% and new onset of TED in 3.5%
• RCP Concise Guidelines Compiled and published national guidelines: Perros P et al. Management of patients with Graves' orbitopathy: initial assessment, management outside specialised centres and referral pathways. Clin Med. 2015;15:173-8

In May 2014 TEAMeD produced its first report. Click here for the executive summary and here for the full report.

 Publications

• Combined immunosuppression and radiotherapy in thyroid eye disease (CIRTED): a multicentre, 2 × 2 factorial, double-blind, randomised controlled trial. Rajendram R¹, Taylor PN², et al Lancet Diabetes Endocrinol. 2018 Apr;6(4):299-309. doi: 10.1016/S2213-8587(18)30021-4. Epub 2018 Jan 31.

• Article on awareness of TED published 2012: Perros P, Chandler T, Dayan CM, Dickinson AJ, Foley P, Hickey J, Macewen CJ, Lazarus JH, McLaren J, Rose GE, Uddin JM, Vaidya B. Orbital decompression for Graves' orbitopathy in England. Eye (Lond). 2012; 26(3):434-7. doi: 10.1038/eye.2011.323.

• Mitchell AL et al. Diago (Diagnosis of Graves' orbitopathy): An Office Tool for Practising Endocrinologists. International Congress of Endocrinology / Endo 2014
  

• 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. DiaGO results

• 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.

• Perros P, Dayan C, Dickinson AJ, Ezra DG, Hickey JL, Hintschisch C, Kahaly GJ, Lazarus J, Ludgate M, Bartès B, MacEwen C, Mitchell AL, Morris D, O' Connor N, Pearce SH, Rose G, Salvi M, Wiersinga WM, Williamson A. Future research in Graves’ orbitopathy: from priority setting to trial design through patient and public involvement. Thyroid 2015. Future Research in Graves' Orbitopathy

• Smith HB, Porteous C, Bunce C, Bonstein K, Hickey J, Dayan CM, Adams G, Rose GE, Ezra DG. Description and evaluation of the first national patient and public involvement day for thyroid eye disease in the United Kingdom. Thyroid. 2014 Sep;24(9):1400-6. doi: 10.1089/thy.2014.0200. Epub 2014 Jul 21.

• Endocrine Abstracts (2016) 44 OC3.3 DOI:10.1530/endoabs.44.OC3.3 Post-Radioiodine Graves’ Management: The Pragma-Study http://www.endocrine-abstracts.org/ea/0044/ea0044OC3.3.htm

• Endocrine Abstracts (2016) 44 P236 DOI:10.1530/endoabs.44.P236 Increasing awareness of Graves’ orbitopathy with “Early Warning” cards – a TEAMeD multicentre quality improvement project http://www.endocrine-abstracts.org/ea/0044/ea0044P236.htm

• Mellington FE, Dayan CM, Dickinson AJ, Hickey JL, MacEwen CJ, McLaren J, Perros P, Rose GE Uddin J, Vaidya B, Foley P, Lazarus JH, Mitchell A, Ezra DG. Management of thyroid eye disease in the United Kingdom: A multi-centre thyroid eye disease audit. Thyroid Eye Disease Amsterdam Declaration Implementation Group (TEAMeD).Orbit. 2017 Mar 15:1-11. Clin Endocrinol (Oxf). 2017 Jul 29. http://onlinelibrary.wiley.com/wol1/doi/10.1111/cen.13438/full

• Raising Awareness of Graves' Orbitopathy with Early Warning Cards. Mitchell A, Hickey J, Vaidya B, Mason R, Ajjan R, Zammitt N, Perros P, Dayan C; TEAMeD.

• Estcourt S, Hickey J, Perros P, Dayan C, Vaidya B. The patient experience of services for thyroid eye disease in the United Kingdom: results of a nationwide survey. Eur J Endocrinol. 2009; 161(3):483-7. doi: 10.1530/EJE-09-0383
  

Abstracts

• Anna L Mitchell, Nicola Zammitt, Ramzi Ajjan, Bijay Vaidya, Janis Hickey, Petros Perros & Colin Dayan. Increasing awareness of Graves' orbitopathy with Early Warning cards - a TEAMeD multicentre quality improvement project
• Endocrine Abstracts (2016) 44 P236 | DOI: 10.1530/endoabs.44.P236 
• Petros Perros, Colin Dayan, Bijay Vaidya, Graham Williams, John H Lazarus, Janis Hickey, Debbie Willis, Natasha Archer, Jayne Franklyn & Ansu Basu. Post-Radioiodine Graves' Management: The Pragma-Study
• Endocrine Abstracts (2016) 44 OC3.3 | DOI: 10.1530/endoabs.44.OC3.3
• Lorna Pankethman, Janis Hickey, Daniel Ezra, Carrie MacEwen, Anna Mitchell, Petros Perros, Colin Dayan. Thyroid eye disease: how to improve outcomes. 1 December 2018. Optometry Today.

Surveys to determine current compliance with Amsterdam Declaration (AD) recommendations

• Specialist Clinic Survey – survey of 50 patients referred in the last 12 months to document AD targets: referral delays, use of radioiodine, and awareness of smoking.
• Questionnaire to identify where Joint (multidisciplinary) TED clinics are in the UK
• Patient Questionnaire – for completion by a sample of patients who have been treated for TED in the last 12 months. Provides similar information on AD targets: delays in specialist review, percentages of patients being seen in joint clinics, use of radioiodine, awareness of smoking risks and advice given, but also types of treatment they have received and any blind/partially sighted registrations. Results compared with USA data from a similar survey.
• Endocrine clinic questionnaire to raise awareness of TED and need for referral in endocrine clinics – for completion partly by doctor, partly by patients. Questionnaire based on published EUGOGO and Root questions to detect thyroid eye disease.
• 'Post-radiioiodine management of patients with Graves' disease' (PRAGMA) - audit of I-131 use by endocrinologists in patients with TED and use of prophylactic treatment and avoidance of hypothyroidism (supported by a grant from the Society for Endocrinology).
• BOSU (British Ophthalmic Surveillance Unit) survey on incidence of sight-threatening TED in the UK

Guidelines

CONCISE GUIDANCE Management of patients with Graves' orbitopathy: initial assessment, management outside specialized centres and referral pathways.

The UK Thyroid Eye Disease Amsterdam Declaration Implementation Group (TEAMeD) produced guidelines for the management of patients with Graves' orbitopathy, published by the Royal College of Physicians (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. CONCISE GUIDANCE Management of patients with Graves' orbitopathy: initial assessment, management outside specialised
centres and referral pathways. Clinical Medicine 2015 Vol 15, No 2: 1–6).

The full text publication can be accessed and downloaded at the RCP Journal website.

Supplementary source data linked to the above publication can be found here:

• S1: Common symptoms and signs associated with GO
• S2: Diagnostic criteria for Graves' orbitopathy (derived from Bartley et al, 1996)
• S3: Activity and severity assessments for patients with Graves' orbitopathy (adapted from Bartalena et al, 2008).
• S4: DiaGO (Diagnosis of GO): Graves' orbitopathy clinical assessment tool
• S5: Thyroid Eye Disease Early Warning Card

Awards