Q&A: What PCPs need to know about thyroid eye disease

Key takeaways:

• PCPs should work alongside specialists when treating thyroid eye disease, an expert told Healio.
• They may need to manage only thyroid disease until TED progresses and the patient needs more intervention.

Primary care providers can play an important role in the management of an often-overlooked disorder, thyroid eye disease, according to an expert.

In recent years, breakthroughs like the introduction of Tepezza (teprotumumab-trbw, Amgen) have pushed treatment for thyroid eye disease (TED) into a new era. Considering these changes, some PCPs may be unclear as to what role they should play in the treatment of TED.

Healio spoke with Kenneth Beckman, MD, FACS, director of corneal surgery at Comprehensive Eyecare of Central Ohio and a clinical assistant professor of ophthalmology at the Ohio State University, to learn more about TED, how involved PCPs should be in its management and more.

Healio: What do you want PCPs to know about TED?

Beckman: It is important for PCPs to recognize that, in patients with known thyroid disease, they should be followed by an eye care professional (ECP). Also, in patients who have eye findings (signs or symptoms) of TED, they should be evaluated for thyroid disease if they have not yet been diagnosed.

Healio: Can you walk us through the standard of care for TED?

Beckman: This is a really complex question because there are so many variables. In general, it is a good idea for patients with thyroid disease to have an ECP following them. If a patient presents to the PCP with no history of thyroid disease but findings that could be related, they should be worked up and sent to an ECP to manage the eye findings (whether they have thyroid disease or not). If a patient with known thyroid disease develops findings of TED and presents to the ECP, they need to be evaluated for further intervention. This may be as simple as treating the surface but may also involve more extensive treatment such as steroids, Tepezza or surgery.

Healio: To what extent should PCPs be involved in the treatment or management of TED?

Beckman: Initially, the PCP may need to manage only the thyroid disease itself. But, if the TED progresses and the patient needs more intervention, the PCP may need to be involved. Often, the patient may need steroids or Tepezza, and these involve systemic monitoring of blood sugar, among other things. The PCP is likely the one who will be monitoring any systemic effects of these treatments.

Healio: Would you like to see greater awareness or involvement from endocrinologists regarding the diagnosis and treatment of TED? If so, why?

Beckman: Yes. Although thyroid disease is common and easily detected by the PCP and endocrinologist, TED is often overlooked. In the past, we just monitored the patient from an eye standpoint until they were severe and needed surgery, steroids, etc. Now we know that we may be able to intervene sooner with Tepezza. Also, we now know how often thyroid is the underlying cause of eye findings and was not evaluated before. When patients have findings such as nonresponse to conventional dry eye therapy or unexplained aching around the eyes, TED is often the cause, yet the patient may have no pre-existing history of thyroid disease. They need an evaluation.

Healio: Is there anything else you would like to add?

Beckman: Thyroid function does not correlate with TED. We may see a patient with well-controlled thyroid disease and normal thyroid function testing yet still has TED. This disease should not be ignored just because the thyroid function tests are normal.