Cureus · 2026
Thyroid Eye Disease, Glycemic Control, and the Role of a One-Stop Clinic Approach: A Retrospective Audit Study.
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Carter Keiko, Khan Zahid, Mahamud Bashir, Hussein Furhana, Abdullah Adnan, Simon Godwin, Mlawa Gideon
Аннотация
BACKGROUND: Thyroid eye disease (TED) is a serious medical condition observed in patients with thyroid disorders, and patients often present in emergencies, threatening their vision.
METHODOLOGY: This retrospective audit was conducted at Queens Hospital, Romford, and included patients with TED who attended a dedicated ophthalmology-led TED clinic between January 2018 and June 2024. A total of 221 patients were included in this study, and their data were extracted from electronic and paper medical records, including clinic letters. Baseline and post-treatment glycemic monitoring was incompletely documented among steroid-treated patients (n=29). Baseline fasting glucose levels prior to steroid initiation were documented in 12 of 29 (41.4%) patients, and follow-up fasting glucose levels after steroid completion were documented in five of 29 (17.2%) patients.
RESULTS: This study included 221 patients who visited the ophthalmology-led TED clinic between January 2018 and June 2024. The study cohort comprised 69% female and 31% male patients, with a mean age of 56.52 years (range, 22-92 years). Of the overall cohort, 29 patients (13.1%), aged 29-85 years, who received oral or intravenous systemic glucocorticoids for TED, were included in the main analysis group. Within this subgroup, four of 29 patients (13.8%) had pre-existing diabetes.
CONCLUSION: Glucose and HbA1c monitoring during systemic glucocorticoid therapy in patients with TED at this center was incomplete and fell below evidence-based recommendations, despite the recognised risk of steroid-induced hyperglycemia and new-onset diabetes with high-dose steroid exposure. There is a need for more standardised and improved care for patients with TED presenting to outpatient clinics. We recommend setting up a "one-stop" TED clinic to provide standardised care.
METHODOLOGY: This retrospective audit was conducted at Queens Hospital, Romford, and included patients with TED who attended a dedicated ophthalmology-led TED clinic between January 2018 and June 2024. A total of 221 patients were included in this study, and their data were extracted from electronic and paper medical records, including clinic letters. Baseline and post-treatment glycemic monitoring was incompletely documented among steroid-treated patients (n=29). Baseline fasting glucose levels prior to steroid initiation were documented in 12 of 29 (41.4%) patients, and follow-up fasting glucose levels after steroid completion were documented in five of 29 (17.2%) patients.
RESULTS: This study included 221 patients who visited the ophthalmology-led TED clinic between January 2018 and June 2024. The study cohort comprised 69% female and 31% male patients, with a mean age of 56.52 years (range, 22-92 years). Of the overall cohort, 29 patients (13.1%), aged 29-85 years, who received oral or intravenous systemic glucocorticoids for TED, were included in the main analysis group. Within this subgroup, four of 29 patients (13.8%) had pre-existing diabetes.
CONCLUSION: Glucose and HbA1c monitoring during systemic glucocorticoid therapy in patients with TED at this center was incomplete and fell below evidence-based recommendations, despite the recognised risk of steroid-induced hyperglycemia and new-onset diabetes with high-dose steroid exposure. There is a need for more standardised and improved care for patients with TED presenting to outpatient clinics. We recommend setting up a "one-stop" TED clinic to provide standardised care.