Eyecon 2024: Thyroid Eye Disease in focus

Wendy Lee, MD, sat down with Ophthalmology Times to discuss a symposium she participated in at Eyecon 2024 focusing on Thyroid Eye Disease.

Video Transcript:

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

David Hutton:

I'm David Hutton of Ophthalmology Times. The Ophthalmology Times/Optometry Times EyeCon 2024 event is taking place at the Hilton Fort Lauderdale Marina on September 27-28. At the event, Dr. Wendy Lee participated in a symposium titled TED in Focus: A Guide to Accurate Diagnosis and Collaborative, Multidisciplinary care for Thyroid Eye Disease. Thank you for joining me. Could you tell me some of the key points of this symposium?

Wendy Lee, MD:

Yeah, sure. This symposium is great because we discuss the pathophysiology of thyroid eye disease. We discuss a little bit about thyroid disease in general, but how it impacts patients' lives, how the patients present so signs and symptoms, how to diagnose it, differential diagnosis of thyroid eye disease, really good clues to how providers can pick up on thyroid eye disease. When to refer, how to treat, so different treatment options. You know, the active versus the chronic phase of the disease. And then, really getting into great case reports. So, a couple of case reports which can highlight the difficulty in diagnosing thyroid eye disease, and then another case on the difficulty in treating thyroid eye disease.

David Hutton:

What are the most common diagnostic challenges you face when identifying early stage thyroid eye disease, and how can they be overcome?

Wendy Lee, MD:

Yeah, you know, I would say some of these patients with thyroid disease have very, very subtle signs of of eye disease, which can be perhaps just dry eye disease, because with thyroid disease and thyroid eye disease, the lid retracts. You get a little bit of proptosis. The entire ocular surface gets shifted forward, making it more exposed to the air. So you may only notice, or the patient may only have subtle dry eyes to begin with. In addition, you know, the most common signs and symptoms are eyelid retraction, proptosis. The differential diagnosis for those signs are multiple. You don't want to miss an orbital tumor. You don't want to miss any brain issues, any trauma, things like that. So, I think it's important to know what could be on your differential and be able to parse those out and see see what points towards thyroid or not.

David Hutton:

How do you approach integrating care between ophthalmologists, endocrinologists and other specialties in managing TED to ensure the best outcomes?

Wendy Lee, MD:

Definitely a multi specialty approach is most optimal for these thyroid patients. They definitely need an endocrinologist to help control the systemic disease, and I personally like working together with the patient's endocrinologist with the patient's neuro ophthalmologists, if they're under the care of a neuro ophthalmologist. For instance, if they have compressive optic neuropathy, or with their strabismus surgeon, if they happen to have diplopia or issues like that. With ENT if they have any hearing issues from possible treatment. So, I think that a multi-disciplinary approach to patient care and thyroid disease is absolutely essential.

David Hutton:

And lastly, how do you educate Ted patients about the importance of that multi-disciplinary approach, and what strategies do you use to ensure they adhere to treatment plans across the different specialties?

Wendy Lee, MD:

First of all, most of my patients, thankfully, come under the care of an endocrinologist already. But I will say that I have had several who don't have endocrinologist, so I find it my responsibility to get them hooked up with them. I'll try to reach out to an endocrinologist myself and make that connection. As well, we've got a great multi-specialty clinic here at Bascom Palmer, so I'll see my patients with an endocrinologist on a given day, which is very helpful, because we bounce ideas off of each other. The patient gets to learn. We get to learn. So, I think that's that's really important to make it clear why multi-disciplinary approaches are most beneficial for the patient, so they understand why they need the care of multiple different providers. But also making it easy for them, and accessible to them. Maybe I find it easier because I'm in a university setting, so I have a lot of connections, but I think it's very easy to do in the private setting as well.