A Chinese Survey of Clinical Practice on the Management of Thyroid Eye Disease

Abstract

objective：The management of thyroid eye disease (TED) has undergone significant changes for decades. The study sought to investigate current clinical practice on the management of TED in China.

Methods: An online questionnaire survey was conducted from April to May 2023. The questionnaire involved diagnostic criteria for TED, multidisciplinary treatment (MDT) collaboration, and treatment preference for mild, moderate, and severe TED.

Results: A total of 289 questionnaires were collected, with 165 from endocrinologists and 124 from ophthalmologists. Only 36.68% participants claimed there was MDT clinical pattern for TED in their institutions. The coverage of biologic agents was around 10% or lower. These were distinctly lower than western countries. 62.63% participants believed the incidence of TED has increased in recent years. Imaging techniques were used widely to assist in the diagnosis of TED. However, there was still controversy regarding the definition of proptosis in Chinese population. Most doctors managed risk factors and provided orbital supportive treatments of artificial tears and glasses. For mild active TED, endocrinologists (39.39%) inclined to recommend therapy for hyperthyroidism alone and ophthalmologists (43.55%) preferred orbital corticosteroid injections. Currently, the most widely used treatment for moderate to severe active TED was high-dose intravenous corticosteroid (94.81%), while orbital radiotherapy combined with immunosuppressive agents was the most recognized second-line therapy (43.60%).

Conclusion: The study documented the consistency and differences between current clinical practices on the management of TED in China and the recently updated guidelines. There was a remarkable difference between ophthalmology and endocrinology departments, warranting management optimization.