Application of multi-disciplinary team clinic in thyroid eye disease_West China Medical Journal

Authors：

DAI Jialing ¹ , HE Qian ¹ ,  HE Weimin ²

1. Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

HE Weimin, Email: hewm888@hotmail.com

Keywords：

Thyroid eye disease; multi-disciplinary team; clinic

DOI：

10.7507/1002-0179.202308061

Video：

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Objective To analyze the implementation of multi-disciplinary team (MDT) clinic for thyroid eye disease (TED) and explore the significance of TED MDT clinic. Methods A retrospective analysis was conducted on the medical records of patients who visited TED MDT clinic at West China Hospital of Sichuan University between December 1, 2022 and November 30, 2024. Patient condition indicators were collected and MDT outpatient operation indicators were statistically analyzed. Results During the study period, a total of 696 patients were admitted to the TED MDT clinic, with an average age of (51.14±12.00) years. All patients were diagnosed with TED and showed symptoms of extraocular muscle involvement and restricted eye movement. According to the NOSPECS clinical grading system, all patients were classified as grade 4 or above. Among them, 693 patients’ orbital enhanced MRI showed that the extraocular muscles were in an inflammatory active phase, and 690 patients received periarbital injection of triamcinolone acetonide, precise orbital radiation therapy, and thyroid function regulation. During the research period, TED MDT clinic received a total of 90 visits, with an average of 7.73 patients per visit. The patient satisfaction rate was 99.67%, and there were no cases of experts being late, absent, or doctors with insufficient qualifications to participate in discussions. Conclusion The TED MDT clinic has been well developed, and the experts within the team attach great importance to it, making it valuable for continued large-scale promotion.

1.	Wang Y, Smith TJ. Current concepts in the molecular pathogenesis of thyroid-associated ophthalmopathy. Invest Ophthalmol Vis Sci, 2014, 55(3): 1735-1748.
2.	国家卫生健康委员会. 肿瘤多学科诊疗试点工作方案(2018-2020 年). 北京: 国家卫生健康委员会, 2018.
3.	Alexandersson N, Rosell L, Wihl J, et al. Determinants of variable resource use for multidisciplinary team meetings in cancer care. Acta Oncol, 2018, 57(5): 675-680.
4.	Prabhakar CN, Fong KM, Peake MD, et al. The effectiveness of lung cancer MDT and the role of respiratory physicians. Respirology, 2015, 20(6): 884-888.
5.	代佳灵, 何为民, 何谦. 多学科诊疗活动期重度甲状腺相关眼病一例. 华西医学, 2024, 39(1): 164-166.
6.	Bartley GB, Gorman CA. Diagnostic criteria for Graves’ ophthalmopathy. Am J Ophthalmol, 1995, 119(6): 792-795.
7.	曾鹏, 余韵, 范淑贤, 等. 甲状腺相关眼病的 EUGOGO 临床分级特征. 中山大学学报(医学科学版), 2018, 39(6): 884-890.
8.	Abukar AA, Ramsanahie A, Martin-Lumbard K, et al. Availability and feasibility of structured, routine collection of comorbidity data in a colorectal cancer multi-disciplinary team (MDT) setting. Int J Colorectal Dis, 2018, 33(8): 1057-1061.
9.	Grover S, Chiyapo SP, Puri P, et al. Multidisciplinary gynecologic oncology clinic in botswana: a model for multidisciplinary oncology care in low- and middle-income settings. J Glob Oncol, 2017, 3(5): 666-670.
10.	国家卫生健康委, 国家中医药管理局. 改善就医感受提升患者体验主题活动方案(2023-2025 年). 北京: 国家卫生健康委, 2023.
11.	陈威, 赵红, 王娜, 等. 医疗机构推广多学科诊疗案例分析. 中华医院管理杂志, 2019, 35(4): 302-306.
12.	Muralidhar A, Das S, Tiple S. Clinical profile of thyroid eye disease and factors predictive of disease severity. Indian J Ophthalmol, 2020, 68(8): 1629-1634.
13.	Tramunt B, Imbert P, Grunenwald S, et al. Sight-threatening Graves’ orbitopathy: twenty years’ experience of a multidisciplinary thyroid-eye outpatient clinic. Clin Endocrinol (Oxf), 2019, 90(1): 208-213.
14.	Du B, Wang Y, Yang M, et al. Clinical features and clinical course of thyroid-associated ophthalmopathy: a case series of 3620 Chinese cases. Eye (Lond), 2021, 35(8): 2294-2301.
15.	Rivera-Grana E, Lin P, Suhler EB, et al. Methotrexate as a corticosteroid-sparing agent for thyroid eye disease. J Clin Exp Ophthalmol, 2015, 6(2): 422.
16.	Werner SC. Modification of the classification of the eye changes of Graves’ disease. Am J Ophthalmol, 1977, 83(5): 725-727.
17.	李冬梅, 姜雪. 规范甲状腺相关眼病眶周注射糖皮质激素的治疗. 中华眼科杂志, 2022, 58(9): 641-645.
18.	Li YJ, Luo Y, He WM, et al. Clinical outcomes of Graves’ ophthalmopathy treated with intensity modulated radiation therapy. Radiat Oncol, 2017, 12(1): 171.
19.	Mikoś H, Mikoś M, Obara-Moszyńska M, et al. The role of the immune system and cytokines involved in the pathogenesis of autoimmune thyroid disease (AITD). Endokrynol Pol, 2014, 65(2): 150-155.
20.	樊琳琳, 吴君丽, 卢颖, 等. 激素冲击治疗联合放射治疗对中重度 Graves 眼病临床疗效分析. 现代生物医学进展, 2016, 16(24): 4734-4736, 4743.

1. Wang Y, Smith TJ. Current concepts in the molecular pathogenesis of thyroid-associated ophthalmopathy. Invest Ophthalmol Vis Sci, 2014, 55(3): 1735-1748.
2. 国家卫生健康委员会. 肿瘤多学科诊疗试点工作方案(2018-2020 年). 北京: 国家卫生健康委员会, 2018.
3. Alexandersson N, Rosell L, Wihl J, et al. Determinants of variable resource use for multidisciplinary team meetings in cancer care. Acta Oncol, 2018, 57(5): 675-680.
4. Prabhakar CN, Fong KM, Peake MD, et al. The effectiveness of lung cancer MDT and the role of respiratory physicians. Respirology, 2015, 20(6): 884-888.
5. 代佳灵, 何为民, 何谦. 多学科诊疗活动期重度甲状腺相关眼病一例. 华西医学, 2024, 39(1): 164-166.
6. Bartley GB, Gorman CA. Diagnostic criteria for Graves’ ophthalmopathy. Am J Ophthalmol, 1995, 119(6): 792-795.
7. 曾鹏, 余韵, 范淑贤, 等. 甲状腺相关眼病的 EUGOGO 临床分级特征. 中山大学学报(医学科学版), 2018, 39(6): 884-890.
8. Abukar AA, Ramsanahie A, Martin-Lumbard K, et al. Availability and feasibility of structured, routine collection of comorbidity data in a colorectal cancer multi-disciplinary team (MDT) setting. Int J Colorectal Dis, 2018, 33(8): 1057-1061.
9. Grover S, Chiyapo SP, Puri P, et al. Multidisciplinary gynecologic oncology clinic in botswana: a model for multidisciplinary oncology care in low- and middle-income settings. J Glob Oncol, 2017, 3(5): 666-670.
10. 国家卫生健康委, 国家中医药管理局. 改善就医感受提升患者体验主题活动方案(2023-2025 年). 北京: 国家卫生健康委, 2023.
11. 陈威, 赵红, 王娜, 等. 医疗机构推广多学科诊疗案例分析. 中华医院管理杂志, 2019, 35(4): 302-306.
12. Muralidhar A, Das S, Tiple S. Clinical profile of thyroid eye disease and factors predictive of disease severity. Indian J Ophthalmol, 2020, 68(8): 1629-1634.
13. Tramunt B, Imbert P, Grunenwald S, et al. Sight-threatening Graves’ orbitopathy: twenty years’ experience of a multidisciplinary thyroid-eye outpatient clinic. Clin Endocrinol (Oxf), 2019, 90(1): 208-213.
14. Du B, Wang Y, Yang M, et al. Clinical features and clinical course of thyroid-associated ophthalmopathy: a case series of 3620 Chinese cases. Eye (Lond), 2021, 35(8): 2294-2301.
15. Rivera-Grana E, Lin P, Suhler EB, et al. Methotrexate as a corticosteroid-sparing agent for thyroid eye disease. J Clin Exp Ophthalmol, 2015, 6(2): 422.
16. Werner SC. Modification of the classification of the eye changes of Graves’ disease. Am J Ophthalmol, 1977, 83(5): 725-727.
17. 李冬梅, 姜雪. 规范甲状腺相关眼病眶周注射糖皮质激素的治疗. 中华眼科杂志, 2022, 58(9): 641-645.
18. Li YJ, Luo Y, He WM, et al. Clinical outcomes of Graves’ ophthalmopathy treated with intensity modulated radiation therapy. Radiat Oncol, 2017, 12(1): 171.
19. Mikoś H, Mikoś M, Obara-Moszyńska M, et al. The role of the immune system and cytokines involved in the pathogenesis of autoimmune thyroid disease (AITD). Endokrynol Pol, 2014, 65(2): 150-155.
20. 樊琳琳, 吴君丽, 卢颖, 等. 激素冲击治疗联合放射治疗对中重度 Graves 眼病临床疗效分析. 现代生物医学进展, 2016, 16(24): 4734-4736, 4743.

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