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Episode 1

Dr. Kossler:
Hello, I'm Dr. Andrea Kossler, and here with me today is a dear friend and a wonderful thyroid eye disease expert, Dr. Kim Cockerham.

Kim, we both treat thyroid eye disease every day, and we know it's a multidimensional condition that affects both visual function and psychosocial well-being. So tell us all, considering the complexity of thyroid eye disease, how do you measure disease activity and disease severity? And how do you use the Clinical Activity Score?

Dr. Cockerham:
Well, thanks, Andrea. This is fun. Great to see you, even if it's on Zoom.

So, thyroid eye disease is a very complex entity. You see here a patient with bulging eyes, redness, eyelid retraction, furrowing of the brow because they're in pain, and each patient deals with it differently. So, while I think the CAS score and all the different scorings are interesting and obviously essential for many insurers, it's really individual to the patient, and so it's their journey, how they interpret their symptoms and signs.

And so as far as the CAS score, it only takes into account redness, swelling, and pain. Yet there’s patients who have very low CAS who are miserable and impact their quality of life significantly. So, while it's part of the issue and part of the things to consider, it's not everything. The quality of life tools are much more important.

So unlike the quality of life tools, it doesn't include the degree of proptosis, how much they see double, their dry eye symptoms, or even optic nerve compression. So the CAS doesn't reflect the impact on the patient's life. How do they drive? Are they able to read? Can they socialize? How do they do screen time? What are their life pursuits? How have they been impacted? So, while the CAS is an important tool, I think it's only part of the things that we utilize now.

So, most frequently, daily activities impacted by thyroid eye disease. This is a study of 146 participants. You can see across the board these patients are significantly impaired across driving, reading, screen activities, being outside, doing activities they love, doing household chores. So very, very limited by the activities. And some of these patients could have had a CAS of 1 or a CAS of 0 and yet still be severely impacted.

But more importantly, thyroid eye disease definitely has impacts on mental health and productivity. And so in these patients, again, the 146 participants, what was most interesting to me was it altered their sleep patterns. So almost 1/3 of patients felt like they weren't sleeping the same. They were depressed, they were anxious, and of course they had work impairment.

So this is a different study, 122 participants, and you can see here patients not only have depression and anxiety, but look at this, they're all worried about getting worse again. And 97% felt as though their physician that they interface with, or group of physicians, they really wanted to tell them more about their journey and how it was impacting them.

So most important is thyroid eye disease symptoms persist over time. So not only are patients extremely symptomatic on presentation, but look at these data on the chronic thyroid eye disease patients. Many patients are significantly impacted, both their quality of life and their needs for intervention.

So, in summary, comprehensive TED assessment includes not only Graves orbitopathy quality of life tools, but other clinical activity scores, the EUGOGO severity assessments, and the VISA scores in certain circumstances.

Dr. Kossler:
Kim, I really loved how you highlight the importance of quality of life and mental health. Such important topics to discuss with our patients. I also think that it's really important to assess the impact that the disease has on their daily activities, and that's something that the EUGOGO severity score does, and I think it does it quite well.

So, if they have no significant impact on their daily activities, then they have mild disease. If they have a significant impact that warrants medical or surgical treatment, then they have moderate to severe disease. So, I really do think that thinking about mental health, quality of life, and the way the disease impacts them helps us to treat our patients in a more customized fashion. So really important topics.

It's been a great discussion and hearing about the work that you've been doing.

Stay tuned for our next episode, where we'll take a closer look at how these tools can improve our ability to tailor treatment strategies. Thanks for joining, and we'll see you at the next episode.

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