Background and Objectives:
Our study was undertaken to chart the evolution of thyroid eye disease (TED) by following thee Clinical Activity Score (CAS) over a period of one year in a tertiary hospital. While the Rundle’s curve described the natural progression of the disease, our study looks at disease activity over time in patients undergoing treatment appropriate to the stage of disease presentation.
Material and Methods
A prospective, observational study was conducted at the out – patient department of the ophthalmology department of a tertiary level care hospital on 30 cases of both sexes. All willing and co–operative patients of thyroid disorder as per clinical & hormonal evaluation were considered for enrollment in the study, except those having other ocular co–morbidities (surgery, glaucoma, uveitis, keratopathy, complicated cataract, trauma). The study was conducted for a period of one and a half years(from 2011 to 2013), where each patient was followed up for a period of one year, with 3 visits of 0, 6 and 12 months for each patient. All patients underwent routine ophthalmological examination along with special stress on TED signs. Changes in CAS was evaluated over a period of one year. All patients were treated for the underlying thyroid disorder in the endocrine department of the tertiary care institute, as per their routine protocol.
Results:
Out of the 26 patients who completed follow–ups, at first visit average CAS <4 was 80%, =4 was 11.5% and > 4 was 7.5%, which evolved in the third visit as <4 about 77%, =4 about 23% and >4 was 0%. A curve was plotted mapping average CAS as per duration of disease and its evolution over one year.
Conclusion:
TED having a chronic course shows a unique trend with newer and better modalities of hormonal control, with a peak of CAS being maximum in the second year of the disease after diagnosis. More data and studies are needed to convey the exact change in the trend of active TED with evolution.