Proposed guideline focuses on individualized approach for thyroid eye disease
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Treatment for thyroid eye disease should be personalized, with joint input from endocrinologists and ophthalmologists, according to two speakers.
The ATA and European Thyroid Association (ETA) presented a brief overview of a proposed joint consensus statement on the management of thyroid eye disease. The statement, which was drafted by a task force of seven thyroidologists and two ophthalmologists from both associations, addresses how providers should approach thyroid eye disease, patient assessment and management based on disease severity.
“Most decisions about treatment are best made jointly between endocrinologists and ophthalmologists, using a shared decision-making framework,” Petros Perros, FRCPE, a consultant endocrinologist at Newcastle upon Tyne Hospitals NHS Trust and Newcastle University in the United Kingdom, and co-chair of the joint consensus statement’s task force, said during the presentation. “We’re at the stage now that treatment for thyroid eye disease can and should be personalized. There are discussions that need to be had about access of all patients with thyroid eye disease to the new, innovative treatments.”
Henry B. Burch, MD, program director of the division of diabetes, endocrinology and metabolic diseases at the National Institute of Diabetes and Digestive and Kidney Diseases of the NIH, and co-chair of the task force, discussed how the consensus statement was written. The task force was selected in October 2020 and conducted a literature search of thyroid eye disease research from 1990 to 2021. Task force members from each organization were paired to collaboratively write about subtopics based on expertise. All of the sections of the statement have been approved by the task force.
“We’re hoping to submit the manuscripts for society review in November,” Burch said. “We’re shooting for publication in early 2022.”
Perros said the proposed guidelines are based on several principles. Firstly, treatment of moderate to severe and sight-threatening thyroid eye disease requires joint input from an endocrinologist and an ophthalmologist. Additionally, providers should engage in shared decision-making with patients.
With most of the changes in thyroid eye disease treatment recently coming in those with moderate to severe disease, all currently available treatments are addressed in the consensus statement.
“We’re in a privileged position now to have choices, three generations of treatments,” Perros said. “There are the traditional ones, the steroids, radiotherapy and cyclosporin have been around for many decades. Then 10, 15 years ago, we had rituximab (Rituxan, Genentech) come in, and then in the last few years, we have teprotumumab-trbw (Tepezza, Horizon Therapeutics) and tocilizumab (Actemra, Genentech). There are still a number of others undergoing clinical trials and these will become available soon.”
The statement advises providers to examine how thyroid eye disease affects each individual’s daily life. Perros noted thyroid eye disease can present differently in people with the same level of activity and severity. Providers should examine dominant symptoms to determine which treatment is best for each patient.
“We are now in a position to select and match treatments based on what dominant feature of the individual patients,” Perros said. “One of the principal newcomers, teprotumumab, has made an impact because it is an effective treatment for proptosis.”
Perros noted potential barriers with each treatment, including relapse, adverse events and cost. All three will be addressed in the consensus statement.
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Burch HB, et al. Thyroid Eye Disease Symposium. Presented at: American Thyroid Association Annual Meeting; Sept. 30-Oct. 3, 2021 (virtual meeting).
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