Patients with suspected dysthyroid eye disease, should be referred to the joint thyroid eye clinic via Dr Justine McKee at PAEP. They will receive both ophthalmic and endocrine follow-up at this clinic. However, if the patient also requires endocrine input, please send a duplicate referral to RIE endocrinology selecting the \u2018Advice only\u2019 option and marking the referral for the attention of Dr Anna Dover or Dr Nicola Zammitt. Patients in West Lothian should be referred to Dr Jan Kerr in ophthalmology. <\/p>\n\n\n\n
Prior to referral, please ensure that the patient has up to date TFTs (TSH, FT4 and TT3) \u2013 within the last 6 weeks at least and TRAb Antibodies within the last 6 months, indicating the suspicion of thyroid eye disease on the request. Patients may have Graves\u2019 eye disease despite being hypothyroid or even euthyroid. The referral can be made while the results are pending.<\/p>\n\n\n\n
Please also ensure that patients:<\/p>\n\n\n\n
ASSESSING DISEASE ACTIVITY.<\/u><\/strong><\/p>\n\n\n\n An assessment of the patient\u2019s disease activity and severity will help determine how urgently they should be seen.<\/p>\n\n\n\n CLINICAL ACTIVITY SCORE (Mourits Score)<\/u><\/strong>:<\/strong><\/p>\n\n\n\n One point for each feature present. A score of >3\/7 indicates active Graves\u2019 Ophthalmopathy (GO) with higher scores indicating more severe disease.<\/p>\n\n\n\n A<\/u> separate picture guide is also available<\/a><\/strong> to assist in assessing clinical activity,<\/p>\n\n\n\n Three other features may indicate active disease<\/u><\/strong>.<\/p>\n\n\n\n In the last 3 months:<\/p>\n\n\n\n ASSESSMENT OF SEVERITY<\/u><\/strong><\/p>\n\n\n\n Severity classification:<\/p>\n\n\n\n 1. Sight threatening GO:<\/span> patients with dysthyroid optic neuropathy (DON) and\/or corneal breakdown. This category warrants immediate intervention.<\/p>\n\n\n\n 2. Moderate to severe GO<\/span>: patients without sight threatening GO whose eye disease has sufficient impact on daily life to justify the risks of immunosuppression (if active) or surgical intervention (if inactive).<\/p>\n\n\n\n Patients with moderate to severe GO usually have any one or more of the following: lid retraction >2mm, moderate or severe soft tissue involvement, exophthalmos >3mm above normal for race and gender, inconstant or constant diplopia.<\/p>\n\n\n\n 3. Mild GO<\/span>: patients whose features of GO have only a minor impact on daily life insufficient to justify immunosuppressive or surgical treatment. They usually only have one or more of the following: minor lid retraction (>2mm), mild soft tissue involvement, exophthalmos >3mm above normal for race and gender, transient or no diplopia, corneal exposure responsive to lubricants.<\/p>\n\n\n\n <\/p>\n\n\n\n HOW SOON SHOULD PATIENTS BE SEEN?<\/p>\n\n\n\n 1.<\/strong> URGENT \u2013 1-2 weeks<\/u><\/strong><\/p>\n\n\n\n Symptoms<\/strong>:<\/p>\n\n\n\n Signs:<\/strong><\/p>\n\n\n\n <\/p>\n\n\n\n 2.<\/strong> NON \u2013 URGENT 1\u20132 months<\/u><\/strong><\/p>\n\n\n\n Unusual presentations of Graves\u2019 eye disease to confirm diagnosis eg. unilateral symptoms and signs, euthyroid eye disease.<\/p>\n\n\n\n Symptoms<\/strong>:<\/p>\n\n\n\n Signs:<\/strong><\/p>\n\n\n\n <\/p>\n\n\n\n 3. No referral is needed for Graves\u2019 Disease with minimal eye symptoms or signs<\/u>.<\/strong><\/p>\n\n\n\n How to refer<\/strong><\/p>\n\n\n\n See introduction above.<\/p>\n<\/div><\/div>\n\n\n\n Picture guide to clinical activity in Thyroid Eye Disease<\/a><\/p>\n\n\n\n Thyroid eye disease PIL<\/a><\/p>\n\n\n\n British Thyroid Foundation PILs<\/a><\/p>\n\n\n\n Patient information on thyroid eye disease can also be found on the Thyroid Eye Disease Charitable Trust (TED-CT)<\/a> website<\/p>\n\n\n\n Thyroid Eye Clinic \u2014 Edinburgh Centre for Endocrinology & Diabetes<\/a> – information for patients.<\/p>\n<\/div><\/div>\n<\/div>\n\n\n\n <\/p>\n","protected":false},"excerpt":{"rendered":" Patients with suspected dysthyroid eye disease, should be referred to the joint thyroid eye clinic via Dr Justine McKee at PAEP. They will receive both ophthalmic and endocrine follow-up at this clinic. However, if the patient also requires endocrine input, please send a duplicate referral to RIE endocrinology selecting the ‘Advice only’ option and marking<\/p>\n","protected":false},"author":7,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[1325],"class_list":["post-25498","page","type-page","status-publish","hentry","category-https-apps-nhslothian-scot-refhelp-thyroid-eye-disease"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"aparnaamanna","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/aparnaamanna\/"},"rttpg_comment":0,"rttpg_category":" Thyroid Eye Disease<\/a>","rttpg_excerpt":"Patients with suspected dysthyroid eye disease, should be referred to the joint thyroid eye clinic via Dr Justine McKee at PAEP. They will receive both ophthalmic and endocrine follow-up at this clinic. However, if the patient also requires endocrine input, please send a duplicate referral to RIE endocrinology selecting the ‘Advice only’ option and marking","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/25498","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/7"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=25498"}],"version-history":[{"count":7,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/25498\/revisions"}],"predecessor-version":[{"id":25581,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/25498\/revisions\/25581"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=25498"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=25498"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}\n
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