Royal Prince Alfred Hospital (RPAH) in Sydney’s inner west, is proving to significantly reduce the burden of treatment, and improve outcomes for patients with thyroid eye disease (TED).
The findings were presented by Associate Professor Raf Ghabrial at RANZCO NSW’s 2023 conference in March. Assoc Prof Ghabrial is a senior surgeon at RPAH and Sydney Eye Hospital, an academic orbital surgeon appointed to the University of Sydney, and the Chief Executive Officer of Sydney Oculoplastic Surgery.
the clinic enables better management of patients with thyroid eye disease…
He said the monthly free clinic – the first of its kind in Australia – involves specialists from ophthalmology, including orbital surgery, strabismus surgery, oculoplastics, and ocular immunology, as well as endocrinology, radiology, and radiation oncology.
Managing a Complex Patient Journey
Established in conjunction with the University of Sydney, the clinic enables better management of patients with TED, the complexities of which often lead to care being delayed and fragmented.
“We often say the patient journey for thyroid eye disease is likely to take about 18 months – however we can’t say whether it will be six or over 36 months,” Assoc Prof Ghabrial explained to the audience of ophthalmologists at the Sydney conference.
“There is a significant burden associated with treatment. Over that time, on average, patients will have five scans, and see six clinicians of different subspecialties. If they’re living in Sydney, they will have driven over 300km; if they live elsewhere in NSW, as many do, they will have driven, or even flown, far further.”
Sydney builder Jason Marsh* has “massively benefited” from the integrated clinic. Diagnosed with Grave’s Disease, which triggered TED, in 2022 he spent seven months unable to work due to his condition.
With jobs placed on hold, under pressure from clients, and living on a significantly reduced income, Mr Marsh was visiting three specialists in an effort to get his TED under control.
My condition fell outside everyone’s field of expertise…
“My condition fell outside everyone’s field of expertise. I’d see one specialist and then it would take another month to see the next. It was very slow and, after seven months, I wasn’t seeing results.
Then I was invited to attend the clinic where I met with about eight doctors, each with different areas of expertise. They bounced ideas off each other and off me and came up with a plan. Within two weeks I was receiving treatment, within another two weeks I was back at work and two weeks later I was living my life again.”
TED is an autoimmune disease that causes inflammation and damage to the tissues around the eye, including muscles, fatty tissue, and connective tissue, leading to proptosis.
Proptosis is the forward displacement of the orbit, which occurs during the active stage of the disease process.
The most common extrathyroidal manifestation of Graves’ hyperthyroidism, it affects approximately 1–2% of adults with a mean age of 45 at diagnosis. It has a five times greater prevalence among females.
Approximately 40% of patients with Graves’ disease will be affected by thyroid eye disease during their lifetime, with a mean onset around 18 months after diagnosis of Graves’ disease.
Smoking is the strongest modifiable risk factor – the disease is five times more common in smokers than non-smokers, and disease severity greater among current smokers.
When presenting on the multidisciplinary clinic at RANZCO NSW, Assoc Prof Ghabrial spoke briefly about a smart phone app he is currently developing, with the support of Sydney Eye Hospital Foundation. The app will monitor patients for proptosis. It is currently going through proof of concept with user interactions, and he hopes to report on clinical and observational findings in the future.
Patients with ocular or cosmetic symptoms of TED should be referred to an ophthalmologist, with urgent referrals required for those with vision-threatening disease. Referrals to the RPAH multidisciplinary clinic should be emailed to SLHD-RPAEyeClinic@health.nsw.gov.au
*Patient name changed for anonymity.
