Thyroid eye disease requires customized treatment approaches
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CHICAGO — New target therapies and improvements in surgical techniques are leading to a change in the expectations and outcomes of patients with thyroid eye disease.
“However, the more we learn about this disease, the more we understand that every patient is different, and no treatment, medical or surgical, works for everybody,” Sara Wester, MD, FACS, said at the American Academy of Ophthalmology meeting.
Treatment strategies are based on two key aspects of the disease: activity and severity. Treating early in the disease is important because the final phase of stable, inactive disease is usually related with permanent abnormalities in function and appearance.
“In a lot of patients, medical treatment works well, but we still don’t know why medications work well in some people and not in others. Or why specific medications, including biologics, are effective in some patients and not in others,” Wester said.
It is important to discuss with patients the pros and cons of different options. In one of her patients, a musician who was concerned with audiology issues, the best choice was tocilizumab rather than the newer biologics that might have better efficacy but carry the risk of hearing loss as a potential side effect.
Indications for surgery have also changed. Orbital decompression is still the gold standard, but the latest survey of the American Society of Ophthalmic Plastic and Reconstructive Surgery showed that specialists have shifted toward more lateral wall decompression, and technical advancements provide a platform for customized surgical approaches.
“Although we have great medicines, surgery still plays an important role,” Wester said.
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Wester S. Take it up an octave! Elevating your treatment of thyroid eye disease. Presented at: American Academy of Ophthalmology meeting; Sept. 30-Oct. 3, 2022; Chicago.
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