1. Thyroid Eye Disease Dr Bijay Vaidya Dept of Endocrinology, Royal Devon & Exeter Hospital, Exeter

3. Pathogenesis of TED NEJM, 2000

4. CT Orbits TED Normal

6. How to Assess TED?

10. Activity vs. Severity of TED BMJ, 2004

13. How to Manage Thyrotoxicosis in a patient with TED?

17. TED After Radioiodine in Smokers & Non-smokers Bartalena, Ann Intern Med, 1998 % Progression of TED (n=82) (n=68) 23% 6%

19. Radioiodine Treatment in Patients with Inactive TED * * * Perros et al., JCEM 2005

21. How to Treat?

23. Is TED Related to Smoking? % Hagg & Asplund, BMJ, 1987 83% 46% 31%

24. Smoking & Risk of TED Odds Ratio P<0.01 1.9 4.4 EJE, 2002

25. Smoking & Response to Treatment Ann Intern Med, 1998

28. Efficacy of Oral Steroids in TED %

31. Efficacy of IV Steroids in TED %

35. Efficacy of Radiotherapy in TED %

40. Randomised Controlled Trial of Octreotide-LAR JCEM, 2004 -8 Octreotide Placebo Octreotide Screening 0 16 32 Weeks 56

41. Clinical Activity Score placebo LAR *** *** ***p <.001

43. Role of Rehabilitative Surgery

44. Impact of TED on Quality of Life Thyroid, 1997

45. % How does/did your TED affect your quality of life?

46. Summary: Management of TED Stop smoking, maintaining euthyroidism & supportive measures All stages IV methylprednisolone decompression Sight-threatening Rehabilitative surgery Moderately severe (inactive) Immuno-suppression and/or radiotherapy Moderately severe (active) ‘ Wait-and-see’ Mild

47. Who to Refer to Specialist TED Clinic?

51. The UK TED Patient Survey: Attend/Attended Specialist TED Clinic? %

52. *p<0.05, ** p<0.01 The UK TED Patients Survey: Specialist TED clinic vs. No Sp TED Clinic % % % % % ** * * *

53. Further Reading: Consensus statement of the European group on Graves' orbitopathy (EUGOGO) on management of Graves' orbitopathy. Eur J Endocrinol. 2008 Mar;158(3):273-85.