Session: SAT 0528-0545-Thyroid Autoimmunity
Poster Board SAT-0543
Aim: To develop and test a clinical assessment tool for use in all patients diagnosed with Graves’ disease (GD). The purpose of the tool is to guide clinicians towards a possible diagnosis of GO in those patients with GD who have orbital signs or symptoms, and thereby prompt earlier ophthalmic referral.
Methods: A 20 point assessment tool was devised, comprising polar (“yes/no”) questions in 2 sections aimed at eliciting GO symptoms and signs. The tool was tested on 104 GD patients in two centres over 17 months: 77 attending endocrine clinic and 27 positive controls with GO attending multidisciplinary thyroid eye clinics. Those referred from endocrine clinics according to protocol were assessed and followed up in the multidisciplinary thyroid eye clinic to determine the appropriateness of referral and whether treatment was initiated.
Results: 88 of the 104 patients (85%) were female: the mean age at assessment was 48.5 years (range 18-76 years). All 27 controls scored above the threshold for referral but none met the criteria for urgent referral. Excluding the controls, 77 people with GD were evaluated using the tool. 27 (35%) scored above the threshold for referral: 2/27 (7%) scored for signs, 6/27 (22%) scored for symptoms and 19/27 (70%) scored for both signs and symptoms. GO was confirmed in 24 (89%) and 14 (58%) were offered 1 or more specific treatments: 2 radiotherapy, 2 orbital decompression, 1 IV steroids and 1 Botulinum toxin treatment. In addition, 7 were prescribed selenium and 5 artificial tears.
Discussion: The timely, accurate diagnosis of GO is important as early intervention in the active phase of disease can improve prognosis. This clinical assessment tool uses polar answers to 20 questions to assist the clinician in making a diagnosis of possible GO and to suggest the need for referral to specialist ophthalmic care. The tool, which is sensitive to the diagnosis of GO, does not require specialist skills in ophthalmic assessment but can quickly and easily be used for assessment of all GD patients in any setting. Overall, over half of those referred following use of this tool were offered specific treatment, suggesting its use might actively alter management of patients who might not otherwise have been referred to specialist ophthalmic care.
Nothing to Disclose: ALM, LM, MM, BV, AJD, AQ, CMD, JM, JLH, JHL, GER, PF, CJM, PP
*Please take note of The Endocrine Society's News Embargo Policy at https://www.endocrine.org/news-room/endo-annual-meeting
See more of: Abstracts - Orals, Poster Preview Presentations, and Posters