Thyroid Eye Disease

Three-year follow-up highlights continuing struggles for patients with thyroid eye disease

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Amongst patients treated for thyroid eye disease, an early reduction in clinical activity score (CAS), a commonly used measure, did not lead to improved long-term outcomes, according to a study.

The 3-year follow-up study from the CIRTED trial found that while some improvements were observed in clinical scores over time, the overall quality of life for patients remained poor.

The trial, which included 126 randomized subjects, assessed the effectiveness of high-dose oral steroids with azathioprine or placebo, along with radiotherapy or sham radiotherapy. The 3-year follow-up data was obtained from 68 of the initial participants (54%).

The results of the study showed no additional benefits for patients randomized to azathioprine or radiotherapy concerning the binary clinical composite outcome measure (BCCOM), modified European Group on Graves’ Orbitopathy score, or Ophthalmopathy Index. However, improvements were observed in CAS, Ophthalmopathy Index, and Total Eye Score over the 3-year period (P < 0.001).

Despite these improvements, the quality of life for patients at the 3-year mark remained poor. Of the 64 individuals with available surgical outcome data, 37.5% required surgical intervention. Notably, the study found that a longer disease duration of over 6 months before treatment was associated with an increased likelihood of surgery.

Higher baseline levels of CAS, Ophthalmopathy Index, and Total Eye Score – but not early improvement in CAS – were linked to an increased requirement for surgery.

Taylor P, Rajendram R, Hanna S, et al. Factors Predicting Long-term Outcome and the Need for Surgery in Graves Orbitopathy: Extended Follow-up From the CIRTED Trial. J Clin Endocrinol Metab. 2023;108(10):2615-2625. doi: 10.1210/clinem/dgad084. PMID: 36971324; PMCID: PMC10505546.