CIME 2024: How an old photograph of a patient can play a role in TED diagnosis

Kelsey Roelofs, MD, details some practical methods to diagnose thyroid eye disease in her presentation, "TED In Focus: Collaborative Strategies for the Management of Thyroid Eye Disease," presented alongside Daniel B. Rootman, MD, MS; Amy Patel Jain, MD; and Selina McGee, OD, FAAO. The 18th Annual Controversies in Modern Eye Care symposium was held May 4, 2024, in Los Angeles.

Video Transcript:

Editor's note: The below transcript has been lightly edited for clarity.

Kelsey Roelofs, MD:

Hi, my name is Kelsey Roelofs. I'm an oculoplastic surgeon. I'm currently an assistant professor at the University of California, Los Angeles. Today I'll be talking a little bit about thyroid eye disease.

Thyroid eye disease is a condition which most commonly affects patients who have Graves hyperthyroidism, but it can happen in other thyroid issues like Hashimoto thyroiditis as well. And in a small portion of patients with thyroid eye disease, their thyroid labs are actually within the normal limits. So we call this euthyroid TED.

Thyroid eye disease presents with a number of different signs and symptoms and there's not really one specific test or diagnostic imaging that we do to diagnose TED. It's based on a constellation of signs and symptoms. So in terms of some of the characteristic or hallmark things that we look for in diagnosing TED, the upper eyelid position can become more retracted with lateral flare. That's very stereotypical of thyroid eye disease. Not many other things will give you upper eyelid retraction and that change in contour. But in some cases, some of the changes in thyroid disease can be more subtle.

So one of my most practical tips, I would say, when you have someone coming to you think might have thyroid eye disease is to ask to see old photos of them. Because on old photos, you can compare what the patient's initial eye morphology or appearance looked like to what they look like in the chair in front of you. It's a really helpful way to pick up on subtle changes in upper eyelid position or contour, or in bulging or proptosis of the eyes. Because we all start out at a different level. Normal is different for each of us and so old photographs, I think, are very, very helpful. So that's basically an overview of what I'll be talking about today.

Early identification of patients who you think might have thyroid eye disease is super important because it can have a really significant negative impact on their quality of life. And so we want to identify those patients as soon as we can so that we can manage them, and in an ideal world optimize their disease course as best as possible.