Call for timely prevention in thyroid eye disease: lessons from the IrTED registry

Area of Science:

• Ophthalmology
• Endocrinology
• Public Health

Background:

• Thyroid eye disease (TED) diagnosis and treatment delays are significant clinical challenges.
• Understanding factors contributing to delayed TED identification is essential for improving patient care.

Purpose of the Study:

• To identify factors associated with delayed diagnosis and treatment of thyroid eye disease (TED).
• To provide recommendations for earlier identification and management of TED patients.

Main Methods:

• Retrospective analysis of data from the Iranian TED (IrTED) registry (March 2013-2023).
• Examination of demographics, clinical activity/severity indices, and factors linked to delayed presentation in 685 TED patients.
• Utilized European Group on Graves' Orbitopathy criteria for classification.

Main Results:

• Mean age at diagnosis was 37.79 years; 37.66% had a first-degree family history of thyroid dysfunction.
• 56.49% had moderate-to-severe TED, 5.40% had sight-threatening TED.
• Men were 5x more likely to have active TED and 10x more likely to have sight-threatening TED. Age increase correlated with higher odds of active and sight-threatening TED.

Conclusions:

• Primary prevention: Identifying relatives of thyroid dysfunction cases can minimize TED progression.
• Secondary prevention: Men and elderly patients require earlier diagnosis to prevent severe presentations.
• Tertiary prevention: The Clinical Activity Score threshold of 3 missed 34.91% of active TED cases, indicating a need for revised assessment.