HOW TO CO-MANAGE THYROID EYE DISEASE (TED)

Hello. I’m Dr. Terry Smith.

It is critical for patients with Graves’ disease and TED to have their thyroid function regulated carefully. As an endocrinologist, I feel that regulating thyroid function in these patients is a primary responsibility of mine. It’s also my responsibility to interface in a productive manner, to synergize the medical care of these patients by involving ophthalmologists if they have not already been involved in case management, and to work as a team, so that the progression of TED can be carefully assessed, both in my office and in the office of my colleagues in ophthalmology.

During a typical clinic visit in my office, I routinely question the patient about their TED symptoms, whether they think that they’re improving or worsening, question them about their vision, and as part of my routine physical examination of these patients, examine the orbit and the eye. In any event, I rely on my ophthalmologic colleagues to routinely reassess these patients to perform such in-office procedures as visual fields and slit lamp examinations. And together, we determine whether and when orbital imaging with MRIs or CT scans is advisable.

It’s of critical importance to identify TED as early as possible. Delaying medical intervention is costly, in that there are aspects of disease development that may be irreversible or be treated with increasing difficulty as the disease progresses.

I advise all patients newly diagnosed with Graves’ disease, to be evaluated at baseline by an ophthalmologist.

It’s very important to make certain that these patients come under the care of ophthalmologists with particular expertise in TED, and that they be followed longitudinally as the endocrinologist continues to monitor and treat their—their Graves’ disease.