{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T08:46:42Z","timestamp":1777366002980,"version":"3.51.4"},"reference-count":21,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,5,7]],"date-time":"2021-05-07T00:00:00Z","timestamp":1620345600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000761","name":"Imperial College London","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000761","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec><jats:title>Background\/Aims<\/jats:title><jats:p>There is no universal consensus on the practical implementation and evaluation of the Amsterdam Declaration on Graves Orbitopathy in a Multidisciplinary Thyroid Eye Disease (MDTED) pathway. Recent recommendations from the UK TEAMeD-5 and BOPSS initiative highlight the importance of prevention, screening, and prompt referral of patients with moderate to severe and sight-threatening thyroid eye disease to multidisciplinary (MDTED) clinics and recommends annual auditing. We propose a practical service evaluation model with Key Performance Indicators (KPI) that are achievable and could be implemented across most TED pathways.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and Methods<\/jats:title><jats:p>We conducted a service evaluation from an integrated TED pathway in London with three MDTED clinics. Data was collected retrospectively from consecutive TED patients included: 1) Patient demographics, 2) Referral to first appointment time, 3) Documented smoking cessation and selenium supplementation advice, 4) Presenting disease activity and severity, 5) Investigations and treatments, including radio-iodine, 6) Time from decision to treatment initiation, 7) Initial and subsequent thyroid status.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The median age was 49.0 yrs, 77.5% (183\/236) were female and 49.5% (101\/204) Afro-Caribbean or Asian. At their first clinic attendance, 47.6% (110\/231) were biochemically euthyroid and 76.7% (79\/103) at discharge. All 23.1% (52\/225) current smokers received smoking cessation advice and 64.8% (153\/236) received selenium supplementation advice. Intravenous methylprednisolone was given to 33.9% (80\/236) patients and 12.7% (30\/236) received second-line immunosuppression. All 7.2% (17\/236) patients with sight-threatening disease received treatment within two weeks of diagnosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This study forms a waymark for other units using TEAMeD-5 and BOPSS audit criteria. Dedicated electronic patient records with ongoing data capture, including quality of life assessments, and diagnostic coding would significantly aid future auditing, improve patient care, and facilitate a national audit of TED management. A future survey when the TED standards have become embedded would be instructive to see whether this has improved TED care.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fendo.2021.669871","type":"journal-article","created":{"date-parts":[[2021,5,7]],"date-time":"2021-05-07T15:49:17Z","timestamp":1620402557000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["A \u2018Real Life\u2019 Service Evaluation Model for Multidisciplinary Thyroid Eye Services"],"prefix":"10.3389","volume":"12","author":[{"given":"Soma","family":"Farag","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claire","family":"Feeney","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vickie","family":"Lee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sonali","family":"Nagendran","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rajni","family":"Jain","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmad","family":"Aziz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rashmi","family":"Akishar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vassiliki","family":"Bravis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karim","family":"Meeran","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2021,5,7]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/j.beem.2011.10.005","article-title":"Epidemiology of Graves\u2019 Orbitopathy (GO) and Relationship With Thyroid Disease","volume":"26","author":"Lazarus","year":"2012","journal-title":"Best Pract Res Clin Endocrinol Metab"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s13023-017-0625-1","article-title":"Graves\u2019 Orbitopathy as a Rare Disease in Europe: A European Group on Graves\u2019 Orbitopathy (Eugogo) Position Statement","volume":"12","author":"Perros","year":"2017","journal-title":"Orphanet J Rare Dis"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1159\/000475973","article-title":"The Amsterdam Declaration on Graves\u2019 Orbitopathy","volume":"20","author":"Perros","year":"2017","journal-title":"Graves\u2019 Orbitopathy Karger Publishers"},{"key":"B4","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1159\/000443828","article-title":"The 2016 European Thyroid Association\/European Group on Graves\u2019 Orbitopathy Guidelines for the Management of Graves\u2019 Orbitopathy","volume":"5","author":"Bartalena","year":"2016","journal-title":"Eur Thyroid J"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s10792-013-9768-9","article-title":"Management of Patients in a Combined Thyroid Eye Clinic in Secondary Care","volume":"34","author":"Benzimra","year":"2014","journal-title":"Int Ophthalmol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1530\/endoabs.50.CMW4.1","article-title":"Improving Outcomes in Thyroid Eye Disease-the Teamed 5 Programme. 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