Coupled medical and surgical treatment needed for TED

Despite the session topic focusing on surgery for patients with inactive thyroid eye disease (TED), Louis A Mawn, MD, Professor Ophthalmology and Neurological Surgery, Vanderbilt University Medical Center told attendees that disease modification remains an important component in treating these patients, in addition to surgery.

“As ophthalmologists, our duty to our thyroid eye disease patients is to first make the diagnosis of thyroid disease and ensure that that disease gets controlled,” she said. “If that disease is controlled, oftentimes were going to have a greatly decreased burden of the thyroid eye disease.”

Dr Mawn questioned the notion that TED has an inactive phase, arguing instead that “active” disease is a spectrum. She said she uses thyroid-stimulating immunoglobulins (TSI) as a biomarker for activity and that it can be detected in virtually all patients with TED and may be predictive of the course of the disease.

“I would argue that without disease modification, our surgery will not succeed and so my approach to the patient with inactive thyroid eye disease is to consider that every patient is potential somewhere on the active curve,” she concluded. “I would argue that the curve is not linear and that even in non-inflammatory patients …the TSI will help you to predict which patients are at greatest risk.”

Dr Mawn discloses that she was an advisor for Horizon Therapeutics in 2020.

Reference
Mawn LA, et al. Surgery for the Inactive Thyroid Eye Disease Patient. Presented at: AAO 2021.