Changing trend in referral to secondary care specialist thyroid eye disease clinic following the Amsterdam declaration.

Abstract

Early diagnosis and treatment of thyroid eye disease (TED) improves outcomes. Previous studies have highlighted delays in diagnosis and referral to specialist centres. The Amsterdam declaration (2009) aimed to halve the time from presentation to diagnosis and from diagnosis to referral to a specialist centre in five years. A recent study from the European group on Graves' orbitopathy tertiary centres showed a trend for earlier referral of patients to the centres. It is unknown whether similar improvements are occurring in secondary care hospitals in the UK. To study the trend in referral to a UK secondary care specialist TED clinic since the Amsterdam declaration. We carried out a prospective audit of patients who attended the specialist TED clinic after the Amsterdam declaration (2010-2015). We compared their clinical characteristics, including duration of symptoms, disease activity and severity, with those of the patients (n=114) from an earlier audit attending the clinic during 2004-2008. During 2010-2015, 126 patients with TED (97 females, median age 55years, 39 current smokers) attended the clinic. The median time from onset of symptoms to being seen in the clinic was 5months, reduced from 12months in 2004-2008 (p<0.001). As compared to the 2004-2008 cohort, significantly more patients in the current cohort presented with mild disease (72 vs. 52%, p=0.002). Twenty-seven per cent patients had active TED (clinical activity score ≥3/7) compared to 18% in 2004-2008 (p=0.1). The trend in referral to secondary care specialist TED clinic is changing in line with the Amsterdam declaration aims.