RETROSPECTIVE ANALYSIS AND EVALUATION OF SPECIALISED MULTIDISCIPLINARY THYROID EYE SERVICES IN A TERTIARY CENTRE IN MALAYSIA

Abstract

INTRODUCTION
Thyroid eye disease (TED) is one of the major extrathyroidal manifestations of Graves’ disease encountered in a variety of clinical settings from primary to tertiary care. Failure to engage appropriate therapeutic options in a timely manner may contribute to a suboptimal outcome. The American Thyroid Association and the European Group on Graves’ Orbitopathy (EUGOGO) highlighted the paramount importance of specialised multidisciplinary clinics for the management of TED. In Malaysia, combined thyroid eye clinics are not readily accessible, and many patients with TED are managed outside multidisciplinary clinics.

METHODOLOGY
We conducted a retrospective evaluation on TED patients treated in our multidisciplinary thyroid eye clinics from March 2021 to March 2023. Data collected for all patients included demographics, endocrine thyroid data, thyroid eye clinical metrics, treatments, and outcomes with comparison between the first and final visits.

RESULTS
Out of 51 patients who attended the clinics, 60.8% (31/51) were female, 76.5% (31/51) were Malays. 23.5% (12/51) were current smokers, and 91.6% (11/12) received smoking cessation advice. Mild, moderate-severe and sightthreatening TED were seen in 35.3%, 47.1% and 17.6%, respectively. Biochemical euthyroidism was attained by 76.7% (33/48) compared to 23% (10/51) from the initial visit (p=0.001). Active TED was seen in 33% (17/51); none were active during the last visit (p=0.001). IV methylprednisolone was given in 23% (12/51) throughout their follow-up. Median cumulative IV methylprednisolone was 4250 mg ± 3937.50. Second-line immunosuppressive therapy was given in 29.4% (15/51). Orbital decompressive surgery was done in 9.8% (5/51) as part of the management of active sight-threatening disease or as rehabilitation surgery. All patients with moderate-severe and sight-threatening disease received their treatment within seven days.

CONCLUSION
Specialised multidisciplinary TED clinics demonstrated favourable outcomes for patients to attain biochemical euthyroidism and improvement in overall TED care.