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Transoral Endoscopic Thyroidectomy Vestibular Approach for Thyroid Lobectomy

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A 'Real Life' Service Evaluation Model for Multidisciplinary Thyroid Eye Services.

Soma Farag^1,2, Claire Feeney^2,3, Vickie Lee^3,4

¹Imperial College School of Medicine, Imperial College London, London, United Kingdom.

Frontiers in Endocrinology

|May 24, 2021

Summary

This study proposes a practical service evaluation model for implementing the Amsterdam Declaration on Graves Orbitopathy within multidisciplinary thyroid eye disease (MDTED) pathways. It highlights achievable Key Performance Indicators (KPIs) for auditing and improving patient care in TED management.

Keywords:

Graves disease Graves ophthalmopathy Graves orbitopathy optic neuropathy thyroid eye disease thyroid-associated ophthalmopathy

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Area of Science:

Endocrinology
Ophthalmology
Clinical Service Evaluation

Background:

Lack of consensus on implementing the Amsterdam Declaration for Graves Orbitopathy in Multidisciplinary Thyroid Eye Disease (MDTED) pathways.
UK TEAMeD-5 and BOPSS initiatives emphasize prevention, screening, and prompt referral for moderate-to-severe and sight-threatening thyroid eye disease (TED).
Annual auditing is recommended for MDTED clinics.

Purpose of the Study:

To propose a practical service evaluation model for MDTED pathways.
To establish achievable Key Performance Indicators (KPIs) for auditing TED management.
To facilitate the implementation and evaluation of the Amsterdam Declaration on Graves Orbitopathy.

Main Methods:

Service evaluation conducted in an integrated TED pathway in London.
Retrospective data collection from consecutive TED patients.
Data included demographics, referral times, advice given (smoking cessation, selenium), disease activity/severity, treatments, and thyroid status.

Main Results:

Median age 49.0 yrs, 77.5% female, significant Afro-Caribbean/Asian population (49.5%).
47.6% euthyroid at first clinic, 76.7% at discharge; smoking cessation and selenium advice provided to relevant patients.
33.9% received IV methylprednisolone, 12.7% second-line immunosuppression; 7.2% with sight-threatening disease treated within two weeks.

Conclusions:

The study provides a model for units using TEAMeD-5 and BOPSS audit criteria.
Dedicated electronic patient records and data capture are crucial for future auditing and improving patient care.
Further surveys are needed to assess the impact of embedded TED standards on patient care.