Combined Thyroid–Eye Clinics in the Management of Graves’ Ophthalmopathy


Patients with Graves’ ophthalmopathy are best served by a multidisciplinary approach by internists/endocrinologists and ophthalmologist/orbital surgeons. A close cooperation between both disciplines is required, especially in coordinating treatment directed at restoration of the euthyroid state and treatment directed at inactivation and rehabilitation of the ophthalmopathy. Combined thyroid–eye clinics guarantee a multidisciplinary approach, and most likely improve the quality of care. EUGOGO recommends referral of all GO patients except mildest cases to such specialist centers. Combined thyroid–eye clinics also create a favorable environment for teaching and research in this area. The 2009 Amsterdam Declaration on Graves’ Orbitopathy has set specific targets for implementing better care and prevention.


Graves’ ophthalmopathy Combined thyroid–eye clinics Multidisciplinary approach Quality of care Teaching Research Amsterdam Declaration 


  1. 1.
    Prummel MF, Wiersinga WM, Mourits MP, Koornneef L, Berghout A, van der Gaag A. Amelioration of eye changes of Graves’ ophthalmopathy by achieving euthyroidism. Acta Endocrinol. 1989;121 Suppl 2:185–9.Google Scholar
  2. 2.
    Acharya SH, Avenell A, Philip S, Burr J, Bevan JS, Abraham P. Radioiodine therapy (RAI) for Graves’ disease (GD) and the effect on ophthalmopathy: a systematic review. Clin Endocrinol (Oxf). 2008;69:943–50.CrossRefGoogle Scholar
  3. 3.
    Tallstedt L, Lundell G, Blomgren H, Bring J. Does early administration of thyroxine reduce the development of Graves’ ophthalmopathy after radioiodine treatment? Eur J Endocrinol. 1994;130:494–7.CrossRefPubMedGoogle Scholar
  4. 4.
    Bartalena L. The dilemma of how to manage Graves’ hyperthyroidism in patients with associated orbitopathy. J Clin Endocrinol Metab. 2011;96:592–9.CrossRefPubMedGoogle Scholar
  5. 5.
    Ducharme A, Doyon O, White M, Rouleau JL, Brophy JM. Impact of care at a multidisciplinary congestive heart failure clinic: a randomized clinical trial. CMAJ. 2005;173:40–5.CrossRefPubMedCentralPubMedGoogle Scholar
  6. 6.
    Sperk-Hillen JM, O’Connor PJ. Factors driving diabetes care improvement in a large medical group: 10 years of progress. Am J Manag Care. 2005;5:S177–85.Google Scholar
  7. 7.
    Estcourt S, Hickey J, Perros P, Dayan C, Vaidya B. The patient experience of services for thyroid eye disease in the United Kingdom: results of a nationwide survey. Eur J Endocrinol. 2009;161:483–7.CrossRefPubMedGoogle Scholar
  8. 8.
    Perros P, Baldeschi L, Boboridis K, Dickinson AJ, Hullo A, Kahaly GJ, Kendall-Taylor P, Krassas GE, Lane CM, Lazarus JH, Marcocci C, Marino M, Mourits MP, Nardi M, Orgiazzi J, Pinchera A, Pitz S, Prummel MF, Wiersinga WM. A questionnaire survey on the management of Graves’ orbitopathy in Europe. Eur J Endocrinol. 2006;155:207–11.CrossRefPubMedGoogle Scholar
  9. 9.
    Bartalena L, Baldeschi L, Dickinson A, Eckstein A, Kendall-Taylor P, Marcocci C, Mourits M, Perros P, Boboridis K, Boschi A, Curro N, Daumerie C, Kahaly GJ, Krassas GE, Lane CM, Lazarus JH, Marino M, Nardi M, Neoh C, Orgiazzi J, Pearce S, Pinchera A, Pitz S, Salvi M, Sivelli P, Stahl M, von Arx G, Wiersinga WM. Consensus statement of the European Group on Graves’ Orbitopathy (EUGOGO) on management of GO. Eur J Endocrinol. 2008;158:273–85.CrossRefPubMedGoogle Scholar
  10. 10.
    Estcourt S, Quinn AG, Vaidya B. Quality of life in thyroid eye disease: impact of quality of care. Eur J Endocrinol. 2011;164:649–55.CrossRefPubMedGoogle Scholar
  11. 11.
    Ponto KA, Pitz S, Pfeiffer N, Hommel G, Weber MM, Kahaly G. Quality of life and occupational disability in endocrine orbitopathy. Dtsch Arztebl Int. 2009;106:283–9.PubMedCentralPubMedGoogle Scholar
  12. 12.
    Kahaly GJ, Petrak F, Hardt J, Pitz S, Egle UT. Psychosocial morbidity of Graves’ orbitopathy. Clin Endocrinol (Oxf). 2005;63:395–402.CrossRefGoogle Scholar
  13. 13.
    Wiersinga WM. Quality of life in Graves’ ophthalmopathy. Best Pract Res Clin Endocrinol Metab. 2012;26:359–70.CrossRefPubMedGoogle Scholar
  14. 14.
    Wright EP, Selby PJ, Crawford M, Gillibrand A, Johnston C, Perren TJ, Rush R, Smith A, Velikova G, Watson K, Gould A, Cull A. Feasibility and compliance of automated measurement of quality of life in oncology practice. J Clin Oncol. 2003;21:374–82.CrossRefPubMedGoogle Scholar
  15. 15.
    Detmar SB, Muller MJ, Schornagel JH, Wever LD, Aaronson NK. Health-related quality-of-life assessments and patient-physician communication. A randomized clinical trial. JAMA. 2002;288:3027–34.CrossRefPubMedGoogle Scholar
  16. 16.
    Prummel MF, Bakker A, Wiersinga WM, Baldeschi L, Mourits MP, Kendall-Taylor P, Perros P, Neoh C, Dickinson AJ, Lazarus JH, Lane CM, Heufelder AE, Kahaly GJ, Pitz S, Orgiazzi J, Hullo A, Pinchera A, Marcocci C, Sartini M, Rocchi R, Nardi M, Krassas GE, Halkias A. Multi-center study on the characteristics and treatment strategies of patients with Graves’ orbitopathy: the first European Group on Graves’ Orbitopathy experience. Eur J Endocrinol. 2003;148:491–5.CrossRefPubMedGoogle Scholar
  17. 17.
    Wiersinga WM, Bleumink M, Saeed P, Baldeschi L, Prummel MF. Is sleeping position related to asymmetry in bilateral Graves’ ophthalmopathy? Thyroid. 2008;18:541–4.CrossRefPubMedGoogle Scholar
  18. 18.
    The European Group on Graves’ Orbitopathy (EUGOGO). Clinical assessment of patients with Graves’ orbitopathy: the EUGOGO recommendations to generalists, specialists and clinical researchers. Eur J Endocrinol. 2006;155:387–9.CrossRefGoogle Scholar
  19. 19.
    Perros P, Wiersinga WM. The Amsterdam declaration on Graves’ orbitopathy. Thyroid. 2010;20:245–6.CrossRefPubMedGoogle Scholar
  20. 20.
    Graves’ orbitopathy: improving outcomes for thyroid eye disease—the Amsterdam Declaration. Thyroid. 2010;20:351–2.Google Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Department of Endocrinology & Metabolism, Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands

Personalised recommendations