A joint presentation by an endocrinologist and ophthalmologist reviewed best practices for managing thyroid eye disease, including when to refer to an ophthalmologist and what tests to run.
The lack of a Hertel exophthalmometer may be the biggest obstacle to optimal endocrine-based eye care, said endocrinologist Chrysoula Dosiou, MD, of Stanford University, Stanford, California.
Of these, the optic nerve exam is most important for assessing disease severity, Freitag said. “Compressive optic neuropathy is the most dreaded finding in thyroid eye disease patients,” she said. “It occurs in about 5% of thyroid eye disease patients and, if untreated, can lead to permanent vision loss.”
“Endocrinologists often expect inflammation but should know that the optic disc is usually not swollen in compressive optic neuropathy,” she added. MRI remains the imaging tool of choice in other regions of the world, said Freitag. “When I’ve used MRI, I thought it was important to give contrast because we want to see how much inflammation is going on,” she said. “But what I learned at the recent American Academy of Ophthalmology meeting is that we don’t need to order contrast for this indication, which makes scheduling easier and saves the patient time in the scanner, the needlestick, and exposure to the contrast agent.
Dosiou and Freitag discussed selection criteria for two of the biologic therapies available to treat thyroid eye disease: The monoclonal antibody teprotumumab, which inhibits the insulin-like growth factor 1 receptor, and the monoclonal antibody tocilizumab, which blocks the activity of interleukin-6.
Patients should be screened and monitored while on teprotumumab, including, where applicable, pregnancy tests at baseline and before each infusion; audiograms at baseline, treatment midpoint, and 6 months post-treatment; fasting blood glucose at baseline and before each infusion; and A1c at baseline, treatment midpoint, and 6 months post-treatment.
Thyroid Disease Thyroid Dysfunction Thyroid Associated Ophthalmopathy Thyroid Eye Disease Thyroid Ophthalmopathy Eye Thyroid Otolaryngology ENT Specialty Head And Neck Surgery ENT Speciality Vision Care And Maintenance Ophthalmologic Trauma Ophthalmologic Injuries Ocular Injury Eye Injuries Biologic Therapy Biologics Referral Compressive Optic Neuropathy
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