About the Thyroid Eye Disease Amsterdam Declaration Implementation Group UK (TEAMeD)

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, the British and Irish Orthoptic Society in 2017, and the Royal College of Physicians of Edinburgh in 2019.

Group	Representative
British Thyroid Foundation	Prof Marian Ludgate
Thyroid Eye Disease Charitable Trust	Prof Colin Dayan (Chair)
British and Irish Orthoptist Society	Lorna Pankethman
Society for Endocrinology	Dr Peter Taylor
Scottish Ophthalmologists Club	Prof Carrie MacEwen
British Thyroid Association	Prof Bijay Vaidya
Royal College of Physicians	Dr Anna Mitchell
Royal College of Physicians of Edinburgh Royal College of Physicians and Surgeons of Glasgow	Dr Nicola Zammitt
British Oculoplastic Surgery Society Royal College of Ophthalmologists	Miss Vickie Lee

Guided by the Amsterdam Declaration, TEAMeD has been 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.

TEAMeD-5 - Improving Outcomes in Thyroid Eye Disease

TED can have a significant and negative impact upon the quality of patient’s lives and visual function.  Delays in making a diagnosis of TED and initiating treatment are common.

“TEAMeD-5”, a 5-point 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.

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.

• Give patients TEAMeD Early Warning Cards (order free of charge here)

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 has now developed standards for specialist ophthalmology care for people with thyroid eye disease. You may also find the BOPSS TED directory a useful guide.

• 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

Eyelid surgery for TED

Research and publications

Thyroid eye disease onformation leaflet 

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