CURRENT MANAGEMENT OF THYROID-ASSOCIATED OPHTHALMOPATHY IN EUROPE - RESULTS OF AN INTERNATIONAL SURVEY

OBJECTIVE To determine how expert thyroidologists assess and treat thy roid-associated ophthalmopathy (TAO), and if TAO affects treatment of coexistent Graves' hyperthyroidism. DESIGN Members of the European Thy roid Association (ETA) were invited to answer a questionnaire which ga ve details of an index patient and nine variants differing in age, sev erity of TAO, thyroid state and the presence of diabetes. Eighty-four responses were received from 19 European countries, representing appro ximately 60% of the clinically active ETA members, RESULTS Disease-mod ifying treatment was not considered necessary by 18% for the index cas e with diplopia and proptosis but 77% used steroids alone or with anot her treatment; 5% used radiotherapy alone and 18% used it in combinati on with steroids. Worsening of eye signs after 8 weeks induced a signi ficant shift away from steroids to radiotherapy, surgery, or other imm unosuppression. For treatment of associated hyperthyroidism, antithyro id drugs were chosen by 84%, thyroidectomy by 10% and radioiodine by 6 %, In recurrent hyperthyroidism, thyroidectomy was preferred by 43%, a ntithyroid drugs by 32%, and radioiodine by 25%, Major alterations in management of TAO were noted for only 2 of the 9 variants. Optic nerve involvement produced a more thorough evaluation of TAO as an in-patie nt, and a preference for surgical decompression (42%). The presence of diabetes induced a greater use of surgery at the expense of steroids, but there was disagreement over the role of radiotherapy in diabetes. CONCLUSION Marked geographical variation was noted, particularly in t he treatment of thyroid-associated ophthalmopathy, Observed consensus was nation-wide rather than Europe-wide. The appropriate treatment of the patient with thyroid-associated ophthalmopathy, especially with di abetes or deteriorating eye signs, is controversial even amongst thyro id specialists.