View 2019 Abstracts

Since 1945 Rundle’s curve is use to describe the temporal activity and severity of thyroid eye disease (TED) . However many patients’ disease do not follow this standard. Also Rundle did not incorporate the course of the endocrine disease. The study aims to explore the temporal relation of Dysthroid optic neuropathy (DON) and subsequent ocular treatment outcomes relative to the course of the endocrine disease to create a multidisciplinary perspective to improve predictive and diagnostic criteria for this syndrome.

A retrospective case note review of DON patients seen at three linked Thyroid MDT clinics. Parameters included patient demographics, clinical and radiological features, timeline and thyroid status and eye disease severity /activity, management and outcome.

There were 17 DON patients (Male 4, Female 13), median age 44yrs(IQR 33-54) . Radio-iodine/Thyroidectomy 59%(10) before DON. 82%(14) were euthyroid at DON diagnosis. Median time to DON diagnosis was 7 months (IQR1-38 months).76% of patients euthyroid patients at DON diagnosis
29% were smokers . 59% had thyroid family history, 23.5% had diabetes. Presenting VA >‪6/12‬ in 47%, Final VA>6/12‬ in 84%. All had EUGOGO DON intravenous steroid treatment . 41% underwent urgent orbital decompression. All required second line treatment. 41% had radiotherapy and 77% had second line immunosuppression.

Presentation of DON can be insidious in euthyroid patients many years after onset of thyroid disease. Orbital decompression is not curative but useful as adjunctive treatment in an emergency setting. Most patients require long term second line immunosuppression and/or radiotherapy to prevent relapse. Viligance is always essential to prevent visual loss.