The primary care physician and thyroid eye disease

Thyroid eye disease (TED) can manifest before, alongside or after a thyroid dysfunction diagnosis. Its unpredictable clinical presentation, onset timing and disease severity may pose significant diagnostic challenges in primary care, where physicians are usually the first point of contact for proactive interim management before specialist referrals.

As MedCentral recently reported, the difficulty in managing TED is further compounded by a limited body of literature specifically addressing TED in primary care, despite the crucial role general practitioners play in diagnosing and managing many medical conditions, including TED. Currently, the joint consensus statement by the American Thyroid Association and European Thyroid Association, along with the European Group on Graves’ Orbitopathy (EUGOGO) guidelines, remain valuable resources for physicians encountering TED.

“There are limited professional guidelines on TED management tailored explicitly to the primary care physician, partly due to insufficient medical evidence to define their role in the overall management scheme,” said Abid Yaqub, MD, professor of clinical medicine and director of the endocrinology fellowship program at the University of Cincinnati College of Medicine. “Most of the guidelines address either endocrinologists or ophthalmologists, and that is where most of the evidence-based data is. Nevertheless, as the role of the PCP expands in response to advances in novel therapies and evolving medical research, it is anticipated that more primary care-focused guidance will emerge."

As the primary provider of long-term care to patients, Yaqub said primary care physicians play a vital role in the management of patients with TED.

“They constitute an integral part of the multidisciplinary triad that also includes an endocrinologist and ophthalmologist. Primary care physicians are frequently involved very early in the patient journey when patients present to them with autoimmune thyroid disease, including Graves’ disease and Hashimoto’s thyroiditis,” he added.

“As a result of their expertise in preventive health care, the PCP can offer timely, consistent advice and intervention on smoking cessation, which is the most important modifiable risk factor in the causation and progression of TED,” Yaqub noted. 

Read MedCentral's full article for when primary care physicians should refer patients for multidisciplinary care.

Featured image at top: A health care provider examines a woman's eyes. Photo/iStock/simarik.