Background: Multiple studies have demonstrated successful radioactive iodine remnant ablation (RR... more Background: Multiple studies have demonstrated successful radioactive iodine remnant ablation (RRA) following preparation with recombinant human thyroid stimulating hormone (rhTSH). Short-term studies in relatively low-risk patients have also suggested that rhTSH-stimulated RRA can have an effective adjuvant therapy function in destroying residual microscopic thyroid cancer cells. However, very few of these studies have included a significant number of intermediate or high-risk patients. The goal of this study was to examine clinical outcomes after rhTSH stimulated RRA in a larger cohort of thyroid cancer patients at higher risk of recurrence and disease-specific mortality. Methods: A retrospective chart review identified 586 thyroid cancer patients prepared for RRA with either a thyroid hormone withdrawal (THW) (n = 321) or rhTSH preparation (n = 265). The primary end points included both the best response to initial therapy and the clinical status at final follow-up. Clinical outcomes were compared within each of the American Thyroid Association (ATA) risk groups (low, intermediate, and high) and American Joint Committee on Cancer (AJCC) stages (I-IV) based on the method of preparation for RRA (THW vs. rhTSH). Results: Preparation with rhTSH was more likely to be associated with an excellent response to therapy (39.4% for rhTSH vs. 30% for TWH, p = 0.03) and fewer additional therapies (29% for rhTSH vs. 37% for TWH, p = 0.05) than THW. However, after a median follow-up period of 9 years, the final clinical outcomes were not significantly different with respect to recurrence rates (1.5% for rhTSH vs. 1.2% for TWH), likelihood of having persistent disease (46% for rhTSH vs. 48% for THW) or likelihood of having no evidence of disease (53% for rhTSH vs. 52% for TWH). Furthermore, clinical outcomes were similar between rhTSH and THW preparation across all ATA risk groups and AJCC stages. Conclusions: rhTSH preparation for RRA is associated with a small, but statistically significant improvement in an initial response to therapy and similar final clinical outcomes across a wide range of risk of recurrence and risk of disease-specific mortality. These data suggest that rhTSH preparation for RRA can be effectively used in intermediate and high-risk patients without known distant metastases.
Background The Royal College of Physicians (RCP) and Thyroid Eye Disease Amsterdam Declaration Im... more Background The Royal College of Physicians (RCP) and Thyroid Eye Disease Amsterdam Declaration Implementation Group (TEAMeD-5) have the common goal of improving access to high quality care for thyroid eye disease (TED). The TEAMeD-5 programme recommends all patients with moderate-to-severe TED should have access to multidisciplinary clinics (MDT) with combined Ophthalmology and Endocrinology expertise. Methods The British Oculoplastic Surgery Society represents oculoplastic surgeons who usually lead TED care in the UK. A two-stage survey of the membership was conducted to ascertain current practice of existing resources. Results Seventy percent (45/65) of respondents in Survey 1 were aware of current RCP guidance, but only 49% (22/45) rated it as a good means of improving access to comprehensive TED service. Sixty percent (39/65) of respondents are working in a multidisciplinary TED clinic with co-location of ophthalmologists and endocrinologists. Care for TED appears not to be provided in a multidisciplinary context in up to 31% (20/65). Thirty five (54%) of the respondents rated their relationship with endocrinology colleagues as good. Best practice guidelines recommend routine quality of life assessments but only 6/28 (21%) of respondents use this modality in current practice. Six percent (4/65) of areas appear not to be using intravenous steroids. In many areas (25%, 16/65), second-line immunosuppression is provided in a different trust and in 8% (5/65), it appears not to be used at all. Conclusion This survey is a 'snapshot' of current TED management in the UK and findings suggest scope for improvement. We recommend a framework for more robust collaboration across specialties and propose standards endorsed by multidisciplinary stakeholder societies.
Significant scientific progress has been achieved in the past decade in thyroidology driven by sc... more Significant scientific progress has been achieved in the past decade in thyroidology driven by scholarly enquiry, unmet patient needs, and investment by the pharmaceutical and diagnostics industry. In this review, nine publications have been selected for their impact in pushing the frontiers of knowledge and understanding. They include new perspectives in the diagnosis, pathophysiology, epidemiology and management of thyroid cancer, understanding of thyroid hormone physiology, and new treatments for Graves' orbitopathy.
To construct a predictive score for the development or progression of Graves' orbitopathy (GO... more To construct a predictive score for the development or progression of Graves' orbitopathy (GO) in Graves' hyperthyroidism (GH). Prospective observational study in patients with newly diagnosed GH, treated with antithyroid drugs (ATD) for 18 months at ten participating centers from EUGOGO in 8 European countries. 348 patients were included with untreated GH but without obvious GO. Mixed effects logistic regression was used to determine the best predictors. A predictive score (called PREDIGO) was constructed. GO occurred in 15% (mild in 13% and moderate to severe in 2%), predominantly at 6-12 months after start of ATD. Independent baseline determinants for the development of GO were clinical activity score (assigned 5 points if score > 0), TSH-binding inhibitory immunoglobulins (2 points if TBII 2-10 U/L, 5 points if TBII > 10 U/L), duration of hyperthyroid symptoms (1 point if 1-4 months, 3 points if >4 months) and smoking (2 points if current smoker). Based on the o...
Clinically significant Graves' orbitopathy (GO) develops in about 25% of those with Graves... more Clinically significant Graves' orbitopathy (GO) develops in about 25% of those with Graves' disease (GD); most cases of GD in the UK are managed by endocrinologists. Despite this, patients report significant delays before a diagnosis of GO is made. Measures to increase awareness of the early signs of GO and establishing a fast-track referral pathway to specialist care should overcome these delays and potentially improve outcomes. We aimed to determine whether issuing a "GO early warning card" to all GD patients raises awareness of GO and facilitates early diagnosis, what percentage of cards result in a telephone contact, the number of "false reports" from card carriers and patient perceptions of the cards. We designed cards, detailing common GO symptoms and a telephone number for patients developing symptoms. Cards were distributed to 160 GD patients, without known GO, attending four endocrine clinics in the UK (December 2015-March 2016). We recorded tele...
Graves' orbitopathy (GO) is uncommon, but responsible for considerable morbidity. A coordinat... more Graves' orbitopathy (GO) is uncommon, but responsible for considerable morbidity. A coordinated approach between healthcare professionals is required in order to meet the needs of patients. Early diagnosis can be achieved by a simple clinical assessment. Low-cost effective interventions can be initiated by generalists, which may improve outcomes. Moderate-to-severe GO should be referred to specialised centres. Recommendations for clinical diagnosis, initial management and referral pathways are highlighted.
The pathogenesis of Graves' orbitopathy (GO) remains unknown. The hypothesis of a causal rela... more The pathogenesis of Graves' orbitopathy (GO) remains unknown. The hypothesis of a causal relationship between autoimmunity against the TSH receptor (TSHR) and GO is supported by clinical studies. Radioiodine treatment is associated with worsening or new onset of GO, possibly via antigen shedding or by inducing hypothyroidism. The coexistence of thyroid cancer with Graves' disease (GD) and GO is rare. Here we report 3 cases of reactivation of GO in patients who underwent treatment with recombinant human TSH (rhTSH) and radioiodine ablation. In each case, a thyroidectomy was performed to treat the GD, and an incidental thyroid cancer was discovered. In all 3 cases, reactivation of GO was observed 3-6 weeks after administration of rhTSH, despite maintaining euthyroidism, which was unaccompanied by a rise in serum TSHR antibodies after radioiodine and despite steroids in 1 of the 3 patients. These observations suggest that binding of either TSH or TSHR antibodies to the TSHR, in...
The Journal of Clinical Endocrinology & Metabolism, 2014
Context: The disease phase in thyroid eye disease (TED) is commonly assessed by clinical investig... more Context: The disease phase in thyroid eye disease (TED) is commonly assessed by clinical investigation of cardinal signs of inflammation and using the clinical activity score (CAS). Although CAS is the current gold standard, the clinical assessment would benefit if a more objective tool were available. Objective: The aim of this work was to explore the clinical value of a novel thermal imaging analysis technique to objectively quantify the thermal characteristics of the eye and peri-orbital region and determine the disease phase in TED. Design: This was a cross-sectional study comparing consecutive patients with active TED (CAS Ն3/7) attending a tertiary center, with a group of consecutive patients with inactive TED (CAS Ͻ3). Patients: Thermal images were acquired from 30 TED patients, 17 with active disease and 13 with inactive disease. Interventions: Patients underwent standard ophthalmological clinical assessments and thermal imaging. Main Outcome Measures: Five novel thermal eye parameters (TEP) were developed to quantify the thermal characteristics of the eyes in terms of the highest level of inflammation (TEP 1), overall level of inflammation (TEP 2), right-left asymmetry in the level of inflammation (TEP 3), maximum temperature variability across the eyes (TEP 4), and right-left asymmetry in the temperature variability (TEP 5). Results: All five TEP were increased in active TED. TEP 1 gave the largest accuracy (77%) at separating the two groups, with 65% sensitivity and 92% specificity. A statistical model combining all five parameters increased the overall accuracy, compared to using only one parameter, to 93% (94% sensitivity and 92% specificity). All five of the parameters were also found to be increased in patients with chemosis compared to those without. Conclusions: The potential diagnostic value of this novel thermal imaging analysis technique has been demonstrated. Further investigation on a larger group of patients is necessary to confirm these results.
... Laricet 1982 : ii: 1353-6. 20 Kendall-Taylor P. Atkinson S. Holcombe M. A specific IgC in Gra... more ... Laricet 1982 : ii: 1353-6. 20 Kendall-Taylor P. Atkinson S. Holcombe M. A specific IgC in Graves' ophthalmopathy and its relation to retro-orbital ... Nadal-Ginard B. Coexpression of multiple myosin heavy chain genes in addition to tissue specific ones in extraocular musculature. ...
Aims The purpose of this study was to obtain data on orbital decompression procedures performed i... more Aims The purpose of this study was to obtain data on orbital decompression procedures performed in England, classed by hospital and locality, to evaluate regional variation in care. Methods Data on orbital decompression taking place in England over a 2-year period between 2007 and 2009 were derived from CHKS Ltd and analysed by the hospital and primary care trust. Results and conclusions In all, 44% of these operations took place in hospitals with an annual workload of 10 or fewer procedures. Analysis of the same data by primary care trust suggests an almost 30-fold variance in the rates of decompression performed per unit population. Expertise available to patients with Graves' orbitopathy and rates of referral for specialist care in England appears to vary significantly by geographic location. These data, along with other outcome measures, will provide a baseline by which progress can be judged.
BackgroundThyroid carcinoma has been reported in patients operated for different types of hyperth... more BackgroundThyroid carcinoma has been reported in patients operated for different types of hyperthyroidism and the probability of a hot nodule being malignant seems to be low. The aim of the present study was to explore the relationship between thyroid cancer, hyperthyroidism and outcome in a large cohort of patients who presented to a tertiary cancer centre in Northern Greece.PatientsAmong 720 patients treated for thyroid cancer, 60 had a concomitant diagnosis of hyperthyroidism due to Graves' disease (n=14), solitary autonomous adenoma (n=17), or multinodular goiter (n=29). Adverse prognostic factors were common in patients with a previous history of hyperthyroidism at the time of diagnosis of thyroid cancer, including cases where the cancer was discovered coincidentally after thyroid surgery for hyperthyroidism and cases where tumor size was more than 10 mm.ResultsIn 10 out of 17 patients with hyperthyroidism due to solitary autonomous adenomas, the tumor was located within th...
Patients with thyroid eye disease, Graves’ orbitopathy (GO), often appear distressed and it is li... more Patients with thyroid eye disease, Graves’ orbitopathy (GO), often appear distressed and it is likely that features of the condition such as disturbances in visual function, orbital discomfort and alterations in facial appearance can impart significant psychological morbidity upon the patient, which in turn can be detrimental to their quality of life. When considering the psychological impact of GO, two elements of the disease are important. The disfiguring changes to the eyes and face can have a direct effect upon psychological health, while physical aspects of the disease such as altered visual acuity, diplopia, orbital pain and lacrimation may influence psychological function as a secondary phenomenon, due to interference with daily living. Evidence appears to confirm the anecdotal impression of many clinicians dealing with GO patients that the prevalence of psychological morbidity in this patient group is high. A ‘biopsychosocial’ approach to care that addresses biological and p...
BackgroundA recent consensus statement from the European Group on Graves' Orbitopathy recomme... more BackgroundA recent consensus statement from the European Group on Graves' Orbitopathy recommends referring all patients with thyroid eye disease (TED), except the mildest cases, to a specialist multidisciplinary clinic.ObjectiveTo study the patients' experiences of accessing services for the treatment of TED in the UK.MethodsA postal questionnaire survey of 395 members of two patients support organisations for TED in the UK, the TED Charitable Trust and the British Thyroid Foundation.ResultsThe response rate was 67%. The majority of responders were females (91%) and aged above 45 (74%). There were delays in the diagnosis and referral. In 26% of responders, the time lapsed from the first symptoms to the diagnosis of TED for over 12 months. There was a wide variation in the type of clinic and healthcare professionals involved in the treatment of TED. Only 25% of the responders attended a specialist TED clinic. Out of these, 33% waited over 6 months from the first consultation ...
Background: Multiple studies have demonstrated successful radioactive iodine remnant ablation (RR... more Background: Multiple studies have demonstrated successful radioactive iodine remnant ablation (RRA) following preparation with recombinant human thyroid stimulating hormone (rhTSH). Short-term studies in relatively low-risk patients have also suggested that rhTSH-stimulated RRA can have an effective adjuvant therapy function in destroying residual microscopic thyroid cancer cells. However, very few of these studies have included a significant number of intermediate or high-risk patients. The goal of this study was to examine clinical outcomes after rhTSH stimulated RRA in a larger cohort of thyroid cancer patients at higher risk of recurrence and disease-specific mortality. Methods: A retrospective chart review identified 586 thyroid cancer patients prepared for RRA with either a thyroid hormone withdrawal (THW) (n = 321) or rhTSH preparation (n = 265). The primary end points included both the best response to initial therapy and the clinical status at final follow-up. Clinical outcomes were compared within each of the American Thyroid Association (ATA) risk groups (low, intermediate, and high) and American Joint Committee on Cancer (AJCC) stages (I-IV) based on the method of preparation for RRA (THW vs. rhTSH). Results: Preparation with rhTSH was more likely to be associated with an excellent response to therapy (39.4% for rhTSH vs. 30% for TWH, p = 0.03) and fewer additional therapies (29% for rhTSH vs. 37% for TWH, p = 0.05) than THW. However, after a median follow-up period of 9 years, the final clinical outcomes were not significantly different with respect to recurrence rates (1.5% for rhTSH vs. 1.2% for TWH), likelihood of having persistent disease (46% for rhTSH vs. 48% for THW) or likelihood of having no evidence of disease (53% for rhTSH vs. 52% for TWH). Furthermore, clinical outcomes were similar between rhTSH and THW preparation across all ATA risk groups and AJCC stages. Conclusions: rhTSH preparation for RRA is associated with a small, but statistically significant improvement in an initial response to therapy and similar final clinical outcomes across a wide range of risk of recurrence and risk of disease-specific mortality. These data suggest that rhTSH preparation for RRA can be effectively used in intermediate and high-risk patients without known distant metastases.
Background The Royal College of Physicians (RCP) and Thyroid Eye Disease Amsterdam Declaration Im... more Background The Royal College of Physicians (RCP) and Thyroid Eye Disease Amsterdam Declaration Implementation Group (TEAMeD-5) have the common goal of improving access to high quality care for thyroid eye disease (TED). The TEAMeD-5 programme recommends all patients with moderate-to-severe TED should have access to multidisciplinary clinics (MDT) with combined Ophthalmology and Endocrinology expertise. Methods The British Oculoplastic Surgery Society represents oculoplastic surgeons who usually lead TED care in the UK. A two-stage survey of the membership was conducted to ascertain current practice of existing resources. Results Seventy percent (45/65) of respondents in Survey 1 were aware of current RCP guidance, but only 49% (22/45) rated it as a good means of improving access to comprehensive TED service. Sixty percent (39/65) of respondents are working in a multidisciplinary TED clinic with co-location of ophthalmologists and endocrinologists. Care for TED appears not to be provided in a multidisciplinary context in up to 31% (20/65). Thirty five (54%) of the respondents rated their relationship with endocrinology colleagues as good. Best practice guidelines recommend routine quality of life assessments but only 6/28 (21%) of respondents use this modality in current practice. Six percent (4/65) of areas appear not to be using intravenous steroids. In many areas (25%, 16/65), second-line immunosuppression is provided in a different trust and in 8% (5/65), it appears not to be used at all. Conclusion This survey is a 'snapshot' of current TED management in the UK and findings suggest scope for improvement. We recommend a framework for more robust collaboration across specialties and propose standards endorsed by multidisciplinary stakeholder societies.
Significant scientific progress has been achieved in the past decade in thyroidology driven by sc... more Significant scientific progress has been achieved in the past decade in thyroidology driven by scholarly enquiry, unmet patient needs, and investment by the pharmaceutical and diagnostics industry. In this review, nine publications have been selected for their impact in pushing the frontiers of knowledge and understanding. They include new perspectives in the diagnosis, pathophysiology, epidemiology and management of thyroid cancer, understanding of thyroid hormone physiology, and new treatments for Graves' orbitopathy.
To construct a predictive score for the development or progression of Graves' orbitopathy (GO... more To construct a predictive score for the development or progression of Graves' orbitopathy (GO) in Graves' hyperthyroidism (GH). Prospective observational study in patients with newly diagnosed GH, treated with antithyroid drugs (ATD) for 18 months at ten participating centers from EUGOGO in 8 European countries. 348 patients were included with untreated GH but without obvious GO. Mixed effects logistic regression was used to determine the best predictors. A predictive score (called PREDIGO) was constructed. GO occurred in 15% (mild in 13% and moderate to severe in 2%), predominantly at 6-12 months after start of ATD. Independent baseline determinants for the development of GO were clinical activity score (assigned 5 points if score > 0), TSH-binding inhibitory immunoglobulins (2 points if TBII 2-10 U/L, 5 points if TBII > 10 U/L), duration of hyperthyroid symptoms (1 point if 1-4 months, 3 points if >4 months) and smoking (2 points if current smoker). Based on the o...
Clinically significant Graves' orbitopathy (GO) develops in about 25% of those with Graves... more Clinically significant Graves' orbitopathy (GO) develops in about 25% of those with Graves' disease (GD); most cases of GD in the UK are managed by endocrinologists. Despite this, patients report significant delays before a diagnosis of GO is made. Measures to increase awareness of the early signs of GO and establishing a fast-track referral pathway to specialist care should overcome these delays and potentially improve outcomes. We aimed to determine whether issuing a "GO early warning card" to all GD patients raises awareness of GO and facilitates early diagnosis, what percentage of cards result in a telephone contact, the number of "false reports" from card carriers and patient perceptions of the cards. We designed cards, detailing common GO symptoms and a telephone number for patients developing symptoms. Cards were distributed to 160 GD patients, without known GO, attending four endocrine clinics in the UK (December 2015-March 2016). We recorded tele...
Graves' orbitopathy (GO) is uncommon, but responsible for considerable morbidity. A coordinat... more Graves' orbitopathy (GO) is uncommon, but responsible for considerable morbidity. A coordinated approach between healthcare professionals is required in order to meet the needs of patients. Early diagnosis can be achieved by a simple clinical assessment. Low-cost effective interventions can be initiated by generalists, which may improve outcomes. Moderate-to-severe GO should be referred to specialised centres. Recommendations for clinical diagnosis, initial management and referral pathways are highlighted.
The pathogenesis of Graves' orbitopathy (GO) remains unknown. The hypothesis of a causal rela... more The pathogenesis of Graves' orbitopathy (GO) remains unknown. The hypothesis of a causal relationship between autoimmunity against the TSH receptor (TSHR) and GO is supported by clinical studies. Radioiodine treatment is associated with worsening or new onset of GO, possibly via antigen shedding or by inducing hypothyroidism. The coexistence of thyroid cancer with Graves' disease (GD) and GO is rare. Here we report 3 cases of reactivation of GO in patients who underwent treatment with recombinant human TSH (rhTSH) and radioiodine ablation. In each case, a thyroidectomy was performed to treat the GD, and an incidental thyroid cancer was discovered. In all 3 cases, reactivation of GO was observed 3-6 weeks after administration of rhTSH, despite maintaining euthyroidism, which was unaccompanied by a rise in serum TSHR antibodies after radioiodine and despite steroids in 1 of the 3 patients. These observations suggest that binding of either TSH or TSHR antibodies to the TSHR, in...
The Journal of Clinical Endocrinology & Metabolism, 2014
Context: The disease phase in thyroid eye disease (TED) is commonly assessed by clinical investig... more Context: The disease phase in thyroid eye disease (TED) is commonly assessed by clinical investigation of cardinal signs of inflammation and using the clinical activity score (CAS). Although CAS is the current gold standard, the clinical assessment would benefit if a more objective tool were available. Objective: The aim of this work was to explore the clinical value of a novel thermal imaging analysis technique to objectively quantify the thermal characteristics of the eye and peri-orbital region and determine the disease phase in TED. Design: This was a cross-sectional study comparing consecutive patients with active TED (CAS Ն3/7) attending a tertiary center, with a group of consecutive patients with inactive TED (CAS Ͻ3). Patients: Thermal images were acquired from 30 TED patients, 17 with active disease and 13 with inactive disease. Interventions: Patients underwent standard ophthalmological clinical assessments and thermal imaging. Main Outcome Measures: Five novel thermal eye parameters (TEP) were developed to quantify the thermal characteristics of the eyes in terms of the highest level of inflammation (TEP 1), overall level of inflammation (TEP 2), right-left asymmetry in the level of inflammation (TEP 3), maximum temperature variability across the eyes (TEP 4), and right-left asymmetry in the temperature variability (TEP 5). Results: All five TEP were increased in active TED. TEP 1 gave the largest accuracy (77%) at separating the two groups, with 65% sensitivity and 92% specificity. A statistical model combining all five parameters increased the overall accuracy, compared to using only one parameter, to 93% (94% sensitivity and 92% specificity). All five of the parameters were also found to be increased in patients with chemosis compared to those without. Conclusions: The potential diagnostic value of this novel thermal imaging analysis technique has been demonstrated. Further investigation on a larger group of patients is necessary to confirm these results.
... Laricet 1982 : ii: 1353-6. 20 Kendall-Taylor P. Atkinson S. Holcombe M. A specific IgC in Gra... more ... Laricet 1982 : ii: 1353-6. 20 Kendall-Taylor P. Atkinson S. Holcombe M. A specific IgC in Graves' ophthalmopathy and its relation to retro-orbital ... Nadal-Ginard B. Coexpression of multiple myosin heavy chain genes in addition to tissue specific ones in extraocular musculature. ...
Aims The purpose of this study was to obtain data on orbital decompression procedures performed i... more Aims The purpose of this study was to obtain data on orbital decompression procedures performed in England, classed by hospital and locality, to evaluate regional variation in care. Methods Data on orbital decompression taking place in England over a 2-year period between 2007 and 2009 were derived from CHKS Ltd and analysed by the hospital and primary care trust. Results and conclusions In all, 44% of these operations took place in hospitals with an annual workload of 10 or fewer procedures. Analysis of the same data by primary care trust suggests an almost 30-fold variance in the rates of decompression performed per unit population. Expertise available to patients with Graves' orbitopathy and rates of referral for specialist care in England appears to vary significantly by geographic location. These data, along with other outcome measures, will provide a baseline by which progress can be judged.
BackgroundThyroid carcinoma has been reported in patients operated for different types of hyperth... more BackgroundThyroid carcinoma has been reported in patients operated for different types of hyperthyroidism and the probability of a hot nodule being malignant seems to be low. The aim of the present study was to explore the relationship between thyroid cancer, hyperthyroidism and outcome in a large cohort of patients who presented to a tertiary cancer centre in Northern Greece.PatientsAmong 720 patients treated for thyroid cancer, 60 had a concomitant diagnosis of hyperthyroidism due to Graves' disease (n=14), solitary autonomous adenoma (n=17), or multinodular goiter (n=29). Adverse prognostic factors were common in patients with a previous history of hyperthyroidism at the time of diagnosis of thyroid cancer, including cases where the cancer was discovered coincidentally after thyroid surgery for hyperthyroidism and cases where tumor size was more than 10 mm.ResultsIn 10 out of 17 patients with hyperthyroidism due to solitary autonomous adenomas, the tumor was located within th...
Patients with thyroid eye disease, Graves’ orbitopathy (GO), often appear distressed and it is li... more Patients with thyroid eye disease, Graves’ orbitopathy (GO), often appear distressed and it is likely that features of the condition such as disturbances in visual function, orbital discomfort and alterations in facial appearance can impart significant psychological morbidity upon the patient, which in turn can be detrimental to their quality of life. When considering the psychological impact of GO, two elements of the disease are important. The disfiguring changes to the eyes and face can have a direct effect upon psychological health, while physical aspects of the disease such as altered visual acuity, diplopia, orbital pain and lacrimation may influence psychological function as a secondary phenomenon, due to interference with daily living. Evidence appears to confirm the anecdotal impression of many clinicians dealing with GO patients that the prevalence of psychological morbidity in this patient group is high. A ‘biopsychosocial’ approach to care that addresses biological and p...
BackgroundA recent consensus statement from the European Group on Graves' Orbitopathy recomme... more BackgroundA recent consensus statement from the European Group on Graves' Orbitopathy recommends referring all patients with thyroid eye disease (TED), except the mildest cases, to a specialist multidisciplinary clinic.ObjectiveTo study the patients' experiences of accessing services for the treatment of TED in the UK.MethodsA postal questionnaire survey of 395 members of two patients support organisations for TED in the UK, the TED Charitable Trust and the British Thyroid Foundation.ResultsThe response rate was 67%. The majority of responders were females (91%) and aged above 45 (74%). There were delays in the diagnosis and referral. In 26% of responders, the time lapsed from the first symptoms to the diagnosis of TED for over 12 months. There was a wide variation in the type of clinic and healthcare professionals involved in the treatment of TED. Only 25% of the responders attended a specialist TED clinic. Out of these, 33% waited over 6 months from the first consultation ...
Uploads
Papers by Petros Perros