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A questionnaire survey on the management of Graves’ orbitopathy in Europe

The European Group of Graves’ Orbitopathy, P Perros, L Baldeschi¹, K Boboridis⁴, A J Dickinson⁵, A Hullo⁶, G J Kahaly⁸, P Kendall-Taylor⁹, G E Krassas¹⁰, C M Lane¹¹, J H Lazarus¹², C Marcocci¹³, M Marino¹³, M P Mourits², M Nardi¹⁴, J Orgiazzi⁷, A Pinchera¹³, S Pitz¹⁵, M F Prummel^3,, W M Wiersinga³

Department of Endocrinology, Freeman Hospital, Newcastle upon Tyne, UK, ¹ Department of Ophthalmology, ² Orbital Center, Department of Ophthalmology, and ³ Department of Endocrinology, Academic Medical Center, Amsterdam, The Netherlands, ⁴ University Department of Ophthalmology, Ahepa Hospital, Thessaloniki, Greece, ⁵ Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, UK, ⁶ Services of Ophthalmology and ⁷ Endocrinology, Centre Hospitalier Lyon-Sud, Lyon, France, ⁸ Department of Medicine I, Gutenberg University Hospital, Mainz, Germany, ⁹ Medical School, University of Newcastle upon Tyne, Newcastle upon Tyne, UK, ¹⁰ Department of Endocrinology, Panagia General Hospital, Thessaloniki, Greece, ¹¹ Cardiff Eye Unit, University Hospital of Wales, Heath Park, Cardiff, UK, ¹² School of Medicine, Cardiff University, Llandough Hospital, Cardiff, UK, ¹³ Departments of Endocrinology and ¹⁴ Neuroscience Section of Ophthalmology, University of Pisa, Pisa, Italy and ¹⁵ Department of Ophthalmology, Johannes Gutenberg-University, Mainz, Germany

(Correspondence should be addressed to P Perros; Email: petros.perros{at}ncl.ac.uk)

Objective: To determine management patterns among clinicians who treat patients with Graves’ orbitopathy (GO) in Europe.

Design and methods: Questionnaire survey including a case scenario of members of professional organisations representing endocrinologists, ophthalmologists and nuclear medicine physicians.

Results: A multidisciplinary approach to manage GO was valued by 96.3% of responders, although 31.5% did not participate or refer to a multidisciplinary team and 21.5% of patients with GO treated by responders were not managed in a multidisciplinary setting. Access to surgery for sight-threatening GO was available only within weeks or months according to 59.5% of responders. Reluctance to refer urgently to an ophthalmologist was noted by 32.7% of responders despite the presence of suspected optic neuropathy. The use of steroids was not influenced by the age of the patient, but fewer responders chose to use steroids in a diabetic patient (72.1 vs 90.5%, P < 0.001). Development of cushingoid features resulted in a reduction in steroid use (90.5 vs 36.5%, P < 0.001) and increase in the use of orbital irradiation (from 23.8% to 40.4%, P < 0.05) and surgical decompression (from 20.9 to 52.9%, P < 0.001). More ophthalmologists chose surgical decompression for patients with threatened vision due to optic neuropathy, who were intolerant to steroids than other specialists (70.3 vs 41.8%, P < 0.01).

Conclusion: Deficiencies in the management of patients with GO in Europe were identified by this survey. Further training of clinicians, easier access of patients to specialist multidisciplinary centres and the publication of practice guidelines may help improve the management of this condition in Europe.

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