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Lookup NU author(s): Dr Anna MitchellORCiD, Dr Bijayeswar Vaidya, Dr Alison Dickinson, Dr Petros PerrosORCiD
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Context: In active Graves' orbitopathy (GO), treatment can improve the final cosmetic and visual outcome. Diagnostic delay results in significant morbidity and increases patient dissatisfaction. However, it can be challenging for endocrinologists to recognize GO and decide who should be referred for ophthalmic care.Objective: DiaGO, a clinical assessment tool, was developed for use in patients with Graves' disease (GD). The tool is designed to alert clinicians to the possibility of GO and prompt early ophthalmic assessment.Design and setting: A 20-point assessment tool was devised and tested on 104 GD patients: 27 "positive controls" with GO and 77 people with GD attending endocrine clinics over 17 months. Those scoring positively in endocrine clinics were referred for ophthalmic assessment. Both the appropriateness of the referral and subsequent treatment were assessed.Results: Eighty-eight of the 104 patients (85%) were female (mean age, 48.5 y; range, 18-76 y). All 27 "controls" scored positively. Of the 77 people evaluated with GD, 27 (35%) scored above the threshold for referral and GO was confirmed in 24/26 (92%) who attended for specialist ophthalmic assessment. Twelve of these 24 (50%) were offered specific treatment following ophthalmology review.Conclusions: The timely diagnosis of GO is important because early intervention in active disease can improve prognosis. DiaGO alerts clinicians to the possibility of GO and prompts referral to specialist ophthalmic care. It is quick and easy to use and does not require specialist ophthalmic skills. Overall, half of those referred after use of DiaGO were offered specific treatment, suggesting its use might significantly improve the management of patients.
Author(s): Mitchell AL, Goss L, Mathiopoulou L, Morris M, Vaidya B, Dickinson AJ, Quinn A, Dayan C, McLaren J, Hickey JL, Lazarus JH, Rose GE, Foley P, MacEwen CJ, Perros P
Publication type: Article
Publication status: Published
Journal: Journal of Clinical Endocrinology & Metabolism
Year: 2015
Volume: 100
Issue: 3
Pages: E458-E462
Print publication date: 01/03/2015
Online publication date: 08/12/2014
Acceptance date: 02/12/2014
ISSN (print): 0021-972X
ISSN (electronic): 1945-7197
Publisher: ENDOCRINE SOC
URL: http://dx.doi.org/10.1210/jc.2014-3146
DOI: 10.1210/jc.2014-3146
PubMed id: 25485725
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