This activity is for healthcare professionals outside of the UK only.

This activity is provided by an independent medical education grant from Horizon Therapeutics. The activity is jointly provided by USF Health and touchIME.

touchIME is an EBAC® accredited provider.

Faculty & Disclosures

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    Faculty & Disclosures
    Dr Andrea Kossler

    Stanford University School of Medicine, Palo Alto, CA, USA

    Dr Andrea Lora Kossler, MD, FACS, is an associate professor of ophthalmology at Stanford University School of Medicine, director of Oculofacial Plastic and Orbital Surgery at the Byers Eye Institute at Stanford and co-director of the Stanford Multidisciplinary Thyroid Eye Disease Clinic in Palo Alto, CA, USA. read more

    Dr Kossler specializes in thyroid eye disease, orbital oncology and orbital surgery. Her research interests include the proteomic evaluation of ocular surface and orbital inflammatory diseases and evaluating targeted therapies for orbital malignancy and thyroid eye disease. Dr Kossler has authored over 100 publications and abstracts and is a national and international speaker on thyroid eye disease and orbital surgery.

    Dr Andrea Kossler discloses: Consulting fees from Acelyrin, Amgen, Argenx, Genentech, Immunovant, Kriya, Lassen and Viridian. Grants/research support from Amgen, Kriya, Lassen, Sling and Viridian.
    Dr Edsel Ing

    University of Alberta, Edmonton and University of Toronto, Ontario, Canada

    Dr Edsel Ing, MD, PhD, FRCSC, MPH, MEd, MIAD, MBA is the professor and chair of Ophthalmology and Visual Sciences at the University of Alberta, and a professor of ophthalmology at the University of Toronto in Canada. read more

    He specializes in oculoplastics, strabismus and neuro-ophthalmology. Dr Ing completed his medical school and residency at the University of Toronto, and three fellowships at Wills Eye, the Mayo Clinic and Allegheny General Hospital. He received his Master of Public Health from Harvard and his Master of Education from Johns Hopkins. Dr Ing’s PhD thesis focused on an ophthalmic diagnostic prediction model and was completed at Kingston University, UK.

    Dr Edsel Ing has no financial interests/relationships or affiliations to disclose in relation to this activity.
    Dr Mario Salvi

    University of Milan, Milan, Italy

    Dr Mario Salvi is head of the Graves’ Orbitopathy Center of the Fondazione IRCCS Cà Granda, Milan, Italy, which he founded in 2003. read more

    Throughout his career, Dr Salvi has pioneered immunotherapy, performing clinical studies with rituximab, belimumab, teprotumumab and tocilizumab in Graves’ orbitopathy, in addition to multicentre trials carried out within the 2021 European Group on Graves’ orbitopathy (EUGOGO). Dr Salvi contributed to the book: ‘Graves’ Orbitopathy: A Multidisciplinary Approach’, edited by EUGOGO, and co-authored the American Thyroid Association/European Thyroid Association Consensus Document on Management of Graves’ Orbitopathy. He has published more than 240 papers (h-index 48) and given over 200 scientific communications and invited lectures at international meetings.

    Dr Mario Salvi discloses: Advisory board/panel fees from Amgen and IBSA. Consulting fees from Aesara, IBSA, Inmagene, Lycia and Tourmaline. Grants/research support from Immunovant, Roche, Sling and Viridian.
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    touchOPHTHALMOLOGY touchOPHTHALMOLOGY
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    Tutorial

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    Poll

    Do you work with or have access to a combined ophthalmology–endocrinology clinic?

    Submit your answer to see the results

    I work in a combined clinic
       
    I refer patients to a combined clinic
       
    There is no local combined clinic
       
    I have no access to a combined clinic
       

    Tutorial

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    Poll

    What is the most common presenting sign of TED in your experience?

    Submit your answer to see the results

    Dry eye symptoms
       
    Eyelid retraction
       
    Proptosis
       
    Diplopia
       

    Tutorial

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    Poll

    Approximately what proportion of your patients with TED have Graves’ disease?

    Submit your answer to see the results

    25%
       
    50%
       
    75%
       
    Nearly all
       
     
    Video Take CE/CME Test
    Ocular Immunology CE/CME accredited

    touchPANEL DISCUSSION
    A visually engaging discussion designed to emulate a ‘live’ panel experience and provide clinicians with practical expert insights to address their clinical challenges. Useful tips below will show how to navigate the activity. Close

    Thyroid eye disease: An evolving continuum of care

    Faculty Podcast Featured
    Useful tips
    • Select in the video player controls bar to choose subtitle language. Subtitles available in English, Saudi Arabia, French, German, Italian, Japanese, Portuguese, Spanish.
    • Downloads including slides are available for this activity in the Toolkit
    Learning Objectives

    After watching this activity, participants should be better able to:

    • Understand the pathophysiology of TED and identify those who are most at risk for developing the disease
    • Recognize the signs and symptoms of TED and the burden of disease in affected patients
    • Describe the process for screening and diagnosing TED
    Overview

    In this activity, three experts provide their perspectives on the mechanisms underlying thyroid eye disease, risk factors, symptomatology and burden of disease in affected patients, as well as the process for screening and diagnosis. The discussion is guided by pre-canvassed questions provided by healthcare professionals involved in the management of patients with thyroid eye disease.

    This activity is jointly provided by USF Health and touchIME. read more

    Target Audience

    This activity has been designed to meet the educational needs of endocrinologists, ENT specialists, ophthalmologists and oculoplastic surgeons (notably trainees/residents), and primary care practitioners involved in the management of patients with thyroid eye disease.

    USF Accreditation

    Disclosures

    USF Health adheres to the Standards for Integrity and Independence in Accredited Continuing Education. All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity. The relevant relationships are listed below. All individuals not listed have no relevant financial relationships.

    Faculty

    Dr Andrea Kossler discloses: Consulting fees from Acelyrin, Amgen, Argenx, Genentech, Immunovant, Kriya, Lassen and Viridian. Grants/research support from Amgen, Kriya, Lassen, Sling and Viridian.

    Dr Edsel Ing has no financial interests/relationships or affiliations to disclose in relation to this activity.

    Dr Mario Salvi discloses: Advisory board/panel fees from Amgen and IBSA. Consulting fees from Aesara, IBSA, Inmagene, Lycia and Tourmaline. Grants/research support from Immunovant, Roche, Sling and Viridian.

    Content reviewer

    John Steven Jarstad, MD, FAAO, FRSM-UK has no financial interests/relationships or affiliations in relation to this activity.

    Touch Medical Contributors

    Christina Mackins-Crabtree has no financial interests/relationships or affiliations in relation to this activity.

    Rebecca Franklin discloses: Independent contractor relationship with Fishawack Communications (relationship terminated).

    USF Health Office of Continuing Professional Development and touchIME staff have no financial interests/relationships or affiliations in relation to this activity.

    Requirements for Successful Completion

    In order to receive credit for this activity, participants must review the content and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

    If you have questions regarding credit please contact cpdsupport@usf.edu 

    Accreditations

    Physicians

    This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through a joint providership of USF Health and touchIME. USF Health is accredited by the ACCME to provide continuing medical education for physicians.

    USF Health designates this enduring material for a maximum of 0.75 AMA PRA Category 1 CreditTM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Advanced Practice Providers

    Physician Assistants may claim a maximum of 0.75 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 CreditTM from organizations accredited by ACCME or a recognized state medical society.

    The AANPCP accepts certificates of participation for educational activities approved for AMA PRA Category 1 CreditTM by ACCME-accredited providers. APRNs who participate will receive a certificate of completion commensurate with the extent of their participation.

    If you have any questions regarding credit, please contact cpdsupport@usf.edu

    EBAC® Accreditation

    touchIME is an EBAC® accredited provider since 2023.

    This programme is accredited by the European Board for Accreditation of Continuing Education for Health Professionals (EBAC®) for 0.75 hours of effective education time.

    The Accreditation Council for Continuing Medical Education (ACCME®), and the Royal College of Physicians and Surgeons of Canada hold an agreement on mutual recognition on substantive equivalency of accreditation systems with EBAC®.

    Through an agreement between the European Board for Accreditation of Continuing Education for Health Professionals and the American Medical Association (AMA), physicians may convert EBAC® CE credits to AMA PRA Category 1 CreditsTM. Information on the process to convert EBAC® credit to AMA credit can be found on the AMA website. Other healthcare professionals may obtain from the AMA a certificate of having participated in an activity eligible for conversion of credit to AMA PRA Category 1 CreditTM.

    Faculty Disclosure Statement / Conflict of Interest Policy

    In compliance with EBAC® guidelines, all speakers/ chairpersons participating in this programme have disclosed or indicated potential conflicts of interest which might cause a bias in the presentations. The Organizing Committee/Course Director is responsible for ensuring that all potential conflicts of interest relevant to the event have been mitigated and declared to the audience prior to the CME activities.

    Requirements for Successful Completion

    Certificates of Completion may be awarded upon successful completion of the post-test and evaluation form. If you have completed one hour or more of effective education through EBAC® accredited CE activities, please contact us at accreditation@touchime.org to receive your EBAC® CE credit certificate. EBAC® grants 1 CE credit for every hour of education completed. 

    Date of original release: 8 August 2024. Date credits expire: 8 August 2025.

    Time to complete: 37 minutes

    If you have any questions regarding the EBAC® credits, please contact accreditation@touchime.org

    This activity is CE/CME accredited

    To obtain the CE/CME credit(s) from this activity, please complete this post-activity test.

    Claim Credit
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    • Downloads including slides are available for this activity in the Toolkit

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    Thyroid eye disease: An evolving continuum of care

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    Ocular Immunology
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    This Activity Is Funded By:

    An independent medical education grant from Horizon Therapeutics and is jointly provided by USF Health and touchIME. touchIME is an EBAC® accredited provider.

    The information provided by this CME activity is for continuing education purposes only and is not meant to substitute for the independent medical/clinical judgement of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.

    USF

    USF is an Equal Opportunity / Affirmative Action / Equal Access Institution.

    USF Health is accredited by the Accreditation Council for Continuing Medical Education, the American Nurses Credentialing Center and the Accreditation Council for Pharmacy Education to provide continuing education to healthcare professionals. As an accredited provider, USF Health is required to disclose personal information to relevant accredited bodies that certify CME to process credits/contact hours, comply with reporting requirements, and for internal recordkeeping and regulatory purposes. USF Health does not share or sell any individual’s contact information or unique identifiers to any commercial supporter, advertiser, or third party without the specific permission of the individual.

    EBAC® 

    Unapproved products or unapproved uses of approved products may be discussed by the faculty; these situations may reflect the approval status in one or more jurisdictions. The presenting faculty have been advised by touchIME and USF Health to ensure that they disclose any such references made to unlabelled or unapproved use. No endorsement by touchIME or USF Health of any unapproved products or unapproved uses is either made or implied by mention of these products or uses in touchIME or USF Health activities. touchIME and USF Health accept no responsibility for errors or omissions.

    touchIME is an EBAC® accredited provider since 2023.

    This content is intended for healthcare professionals.

    Date of original release: 8 August 2024. Date credits expire: 8 August 2025.

    Claim Credit
    touchPANEL DISCUSSION
    Thyroid eye disease: An evolving continuum of care
    0.75 CE/CME credit
    Question 1/5
    Which orbital cells are thought to be central to the pathophysiology of TED, involved in both the early inflammation and subsequent remodelling process?

    TED, thyroid eye disease.

    Bone marrow-derived fibrocytes infiltrate the orbit, become activated and differentiate into CD34+ fibroblasts. Upon activation by thyroid-stimulating antibodies, IGF-1R antibodies and cytokines, CD34+ fibroblasts can proliferate and further differentiate into adipocytes and myofibroblasts. Activated CD34+ fibroblasts can also induce hyaluronan synthesis, cytokine secretion and subsequent inflammation. This leads to orbital tissue expansion, proptosis, compression of the optic nerve and other characteristic clinical manifestations of TED.

    Abbreviations

    IGF-1R, insulin-like growth factor-1 receptor; TED, thyroid eye disease.

    Reference

    Men CJ, et al. Ther Adv Ophthalmol. 2021;13:1–14.

    Question 2/5
    You have a 53-year-old female patient with Graves’ disease. She received radioiodine therapy at age 34 years, her hyperthyroidism is controlled with methimazole, she is receiving statins and is a smoker. How do you help the patient minimize her risk for developing TED?

    TED, thyroid eye disease.

    Cigarette smoking is a key modifiable risk factor for developing TED.1,2 Mechanisms by which cigarette smoking negatively impacts TED may include increased oxygen-free radical generation, hypoxia in the orbit, enhanced cytokines synthesis and stimulation of adipogenesis.1 Among patients with Graves’ disease, TED is positively associated with current smoking compared with non-smoking, in a dose-response pattern.3 Patients with TED who smoke have a poorer response to treatments, such as corticosteroids and teprotumumab, compared with non-smokers.2 Smoking cessation should therefore be recommended to all patients with Graves’ disease.4

    Abbreviation

    TED, thyroid eye disease.

    References

    1. Bartalena L, et al. Ophthalmic Plast Reconstr Surg. 2023;39:S2–8.
    2. Miller O’Dell J, et al. Kans J Med. 2023;16:62–4.
    3. Ramesh S, et al. Am J Ophthalmol. 2023;253:74–85.
    4. Coskun M, et al. Endocr Abstr. 2022;83:TO5.
    Question 3/5
    Which of these statements best summarizes the burden of anxiety and depression among patients with TED?

    TED, thyroid eye disease.

    Compared with the general population, a high prevalence of anxiety and/or depression has been reported in both patients with active, inflammatory TED and in those with inactive, non-inflammatory TED.1–3 Among patients with TED, pain behind the eyes, photosensitivity, blurred vision and diplopia are more prevalent in those with low QoL scores compared with those with high QoL scores.1 Patients with TED have also reported vision and appearance impairment and psychosocial impact long after acute disease has subsided.1,2

    Abbreviations

    TED, thyroid eye disease; QoL, quality of life.

    References

    1. Cockerham KP, et al. Ophthalmol Ther. 2021;10:975–87.
    2. Wang Y, et al. Endocr Pract. 2022;28:842–46.
    3. Lee TC, et al. Ophthalmic Plast Reconstr Surg. 2023;39:281–87.
    Question 4/5
    Your patient is at high risk for developing TED and asks what the early signs might be. Which of the following signs would you include in your advice?

    TED, thyroid eye disease.

    The early signs of TED can be subtle and easily missed.1 Diplopia (double vision) is one of many early diagnostic signs of TED,1 occurring at presentation in around 6–18% of cases.2 During active TED, diplopia may fluctuate, with worsening in the morning.2

    Abbreviation

    TED, thyroid eye disease.

    References

    1. TEDct. 2023. Available at: https://tedct.org.uk/news/early-diagnostic-signs-of-thyroid-eye-disease/ (accessed 11 July 2024).
    2. Shah SS, Patel BC. Thyroid Eye Disease. Updated 2023. Available at: www.ncbi.nlm.nih.gov/books/NBK582134/ (accessed 11 July 2024).
    Question 5/5
    You are an ophthalmologist. A 62-year-old female with controlled Graves’ disease is referred to you from their endocrinologist with suspected TED. They presented with sudden onset of pain, unilateral proptosis, orbital edema and decreased vision. What differential diagnosis would you consider for this patient?

    IgG4, immunoglobulin G4; TED, thyroid eye disease.

    Orbital inflammatory syndrome (also known as nonspecific orbital inflammation, orbital inflammatory pseudotumor and idiopathic orbital inflammation) is typically characterized by the abrupt onset of pain, proptosis and other orbital inflammatory signs such as swelling and erythema, which can be similar to TED. Unilateral presentation is more typical but bilateral presentations occur. The most common orbital processes that present with similar clinical pictures as orbital inflammatory syndrome are TED and orbital cellulitis. Differentiating findings for TED that are not features of orbital inflammatory syndrome include lid retraction, lid lag, optic neuropathy and ocular motility restriction. Laboratory tests showing elevated thyroxine and triiodothyronine, decreased thyroid-stimulating hormone and the presence of stimulating autoantibodies would also indicate TED.

    Abbreviation

    TED, thyroid eye disease.

    Reference

    American Academy of Ophthalmology. 2024. Available at: https://eyewiki.aao.org/Nonspecific

    _Orbital_Inflammation_(Idiopathic_Orbital_Inflammation,_Orbital_Inflammatory_Syndrome,_Orbital_Pseudotumor) (accessed 11 July 2024).

    Back to Activity

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    This Activity Is Funded By:

    An independent medical education grant from Horizon Therapeutics and is jointly provided by USF Health and touchIME. touchIME is an EBAC® accredited provider.

    The information provided by this CME activity is for continuing education purposes only and is not meant to substitute for the independent medical/clinical judgement of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.

    USF

    USF is an Equal Opportunity / Affirmative Action / Equal Access Institution.

    USF Health is accredited by the Accreditation Council for Continuing Medical Education, the American Nurses Credentialing Center and the Accreditation Council for Pharmacy Education to provide continuing education to healthcare professionals. As an accredited provider, USF Health is required to disclose personal information to relevant accredited bodies that certify CME to process credits/contact hours, comply with reporting requirements, and for internal recordkeeping and regulatory purposes. USF Health does not share or sell any individual’s contact information or unique identifiers to any commercial supporter, advertiser, or third party without the specific permission of the individual.

    EBAC® 

    Unapproved products or unapproved uses of approved products may be discussed by the faculty; these situations may reflect the approval status in one or more jurisdictions. The presenting faculty have been advised by touchIME and USF Health to ensure that they disclose any such references made to unlabelled or unapproved use. No endorsement by touchIME or USF Health of any unapproved products or unapproved uses is either made or implied by mention of these products or uses in touchIME or USF Health activities. touchIME and USF Health accept no responsibility for errors or omissions.

    touchIME is an EBAC® accredited provider since 2023.

    This content is intended for healthcare professionals.

    Date of original release: 8 August 2024. Date credits expire: 8 August 2025.

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