Thyroid Eye Disease, Glycemic Control, and the Role of a One-Stop Clinic Approach: A Retrospective Audit Study

Thyroid eye disease (TED) is a serious medical condition observed in patients with thyroid disorders, and patients often present in emergencies, threatening their vision.

This retrospective audit was conducted at Queens Hospital, Romford, and included patients with TED who attended a dedicated ophthalmology-led TED clinic between January 2018 and June 2024. A total of 221 patients were included in this study, and their data were extracted from electronic and paper medical records, including clinic letters. Baseline and post-treatment glycemic monitoring was incompletely documented among steroid-treated patients (n=29). Baseline fasting glucose levels prior to steroid initiation were documented in 12 of 29 (41.4%) patients, and follow-up fasting glucose levels after steroid completion were documented in five of 29 (17.2%) patients.

This study included 221 patients who visited the ophthalmology-led TED clinic between January 2018 and June 2024. The study cohort comprised 69% female and 31% male patients, with a mean age of 56.52 years (range, 22-92 years). Of the overall cohort, 29 patients (13.1%), aged 29-85 years, who received oral or intravenous systemic glucocorticoids for TED, were included in the main analysis group. Within this subgroup, four of 29 patients (13.8%) had pre-existing diabetes.

Glucose and HbA1c monitoring during systemic glucocorticoid therapy in patients with TED at this center was incomplete and fell below evidence-based recommendations, despite the recognised risk of steroid-induced hyperglycemia and new-onset diabetes with high-dose steroid exposure. There is a need for more standardised and improved care for patients with TED presenting to outpatient clinics. We recommend setting up a "one-stop" TED clinic to provide standardised care.