The Benefits of Using a Multidisciplinary TED Clinic for Thyroid Eye Disease

The first symptoms of thyroid eye disease (TED) may show up in the eyes — redness, tearing, a gritty feeling, double vision, or bulging eyes. Treating those symptoms is important. And because TED is commonly linked with Graves’ disease, the most common cause of hyperthyroidism, many people also need help managing thyroid hormone levels, monitoring vision and eye movement, and, in more advanced cases, deciding whether medication or surgery is needed.

For all but the mildest cases, thyroid eye disease care should be managed by both an endocrinologist and an ophthalmologist, says Esra Karslioglu-French, MD, a clinical associate professor of medicine in the division of endocrinology and metabolism at the University of Pittsburgh School of Medicine in Pittsburgh.

A multidisciplinary TED clinic can streamline that management and help coordinate care across specialists, making it easier to manage thyroid levels, track eye changes, and decide when medication or surgery may be needed.

Who Treats Thyroid Eye Disease?

Dr. French says TED care often includes:

• An endocrinologist, who stabilizes thyroid function, orders lab work, starts supportive measures, and helps guide systemic immune treatment
• An ophthalmologist, who checks visual function, confirms TED, and monitors eye symptoms and vision changes
• An orbital or oculoplastic specialist, who may become involved when TED is moderate to severe, sight-threatening, or likely to require surgery
• An orbital surgeon, who may perform staged procedures — such as orbital decompression, eye muscle surgery, and eyelid correction — once TED is inactive and thyroid levels are stable

What Is a Multidisciplinary TED Clinic?

“A multidisciplinary TED clinic keeps endocrinology and ophthalmology tightly aligned, so thyroid control and orbital management progress together,” says French.

The exact setup varies by center — some clinics bring specialists together in the same visit, while others coordinate in-person and virtual visits close together. In either model, the goal is one shared plan instead of separate plans that the patient has to reconcile, she says.

French says a visit or care plan may include:

• Thyroid evaluation and lab review
• Eye assessment and disease activity monitoring
• A plan for medication, urgent treatment, or surgical referral if needed
• Supportive measures, such as lubricating eye drops, prisms for double vision, smoking cessation counseling, or psychological support

Follow-up depends on how active the disease is. “During active TED, the focus may be on reducing inflammation and protecting vision. In the chronic or inactive phase, care shifts toward staged surgical rehabilitation,” says French.

How Can a Multidisciplinary TED Clinic Improve Treatment?

A major benefit of a combined TED clinic is that it streamlines care by allowing endocrinologists and ophthalmologists to make real-time, unified decisions rather than relying on delayed communication between separate visits, says French.

That matters because some TED decisions are time sensitive. Direct communication “protects the narrow treatment window,” she says, since therapies such as IV steroids and teprotumumab (Tepezza) work best when started within the first six months of active disease.

A team-based clinic can be especially useful when one specialist’s assessment changes what another specialist should do.

French points to several key moments in the treatment of thyroid eye disease:

• Starting or adjusting immune-directed therapy, such as IV steroids or teprotumumab
• Deciding whether radioiodine therapy is safe because TED activity and risk factors need to be clear before treatment
• Monitoring medication side effects, including blood sugar changes, hearing changes, and thyroid shifts
• Planning surgery, since staged TED procedures usually need confirmation that the disease is inactive and thyroid levels are stable

“Radioiodine is a high-stakes decision that depends on the ophthalmologist’s precise activity grading, and coordinated clinics prevent unsafe use of RAI when TED is active or moderate to severe,” says French.

For people who need surgery, coordination can also help keep the sequence clear. Team-based clinics can confirm disease inactivity and stable thyroid levels before staged procedures, such as decompression, eye muscle surgery, and eyelid correction, move forward, says French.

How Do I Find a Multidisciplinary TED Clinic?

Multidisciplinary TED clinics are often based at major medical centers, academic hospitals, or specialty eye institutes. They may be called thyroid eye disease clinics, Graves’ orbitopathy clinics, orbital disease clinics, or combined endocrine-ophthalmology clinics.

Start with your endocrinologist or ophthalmologist and ask whether there is a TED-focused clinic or a team that regularly coordinates thyroid and eye care. If you are considering traveling to a clinic, ask what can be handled in one visit and what can be done closer to home.

Useful questions include:

• Can multiple specialists evaluate me during the same trip?
• What records, labs, imaging, and eye exam notes should be sent ahead of time?
• Can infusions, labs, or follow-up monitoring happen locally?
• Will the specialty clinic communicate directly with my local doctors?

“Hybrid models — initial evaluation at a specialized center with ongoing monitoring or infusions done locally — can reduce travel while preserving expert oversight,” says French.

Do I Need a Multidisciplinary TED Clinic?

People with mild, inactive TED may do well with local care, as long as their endocrinologist and ophthalmologist communicate effectively, French says.

A specialty clinic is most worth considering when TED is active, moderate to severe, fast-changing, or possibly sight-threatening. It may also be helpful if you have double vision, eye movement problems, significant bulging, vision changes, active inflammation, or possible surgery needs.

“Patients who benefit most from multidisciplinary TED clinics are those with active, moderate-to-severe or sight-threatening disease, where coordinated endocrine–ophthalmic decisions directly affect outcomes,” says French.

French says closer monitoring and integrated decision-making may be especially important for people at higher risk for severe or progressive TED, including:

• Men
• Older adults
• People who smoke
• People with diabetes
• People with elevated TRAb, or thyroid-stimulating hormone receptor antibodies, a blood marker linked with Graves’ disease and TED activity

If you can’t get to a multidisciplinary clinic, ask your doctors to coordinate with one another as much as possible. French recommends direct communication between endocrinology and ophthalmology so key details — including thyroid status, clinical activity score, thyroid receptor antibody levels, risk factors, and planned treatments — are shared accurately. (A clinical activity score is a tool doctors use to rate how active the eye inflammation is.)

“Scheduling endocrine and eye visits close together around major decisions, such as immunotherapy, radioiodine, teprotumumab monitoring, or surgery planning, can also help keep care aligned,” says French.