Table 2.

Proposed audit criteria for review of services managing thyroid eye disease

(1) Efficacy	Consideration of oral selenium supplements (91.3 mcg elemental selenium bd for 6 months) for patients with mild, active TED.
	Smoking cessation advice for patients who are smokers (Target 80%).
	Prompt correction of dysthyroidism and maintenance of euthyroidism.
	Where systemic steroid treatment is indicated, use of intravenous pulses of methylpred-nisolone in preference to oral steroids.
	Availability of urgent treatment for sight-threatening orbitopathy, including surgical decompression for patients who fail to respond to high dose intravenous steroids.
	Availability of orbital irradiation.
	Availability of rehabilitative surgery for patients with inactive or minimally active disease who are significantly impaired, socially or psychologically as a result of TED.
(2) Safety	Appropriate selection of patients with TED who are being considered for radioiodine for suitability of steroid cover.
	Safe use of immunosuppressive treatments (exclusion of those for whom there are contraindications, assessment and monitoring of risks of serious adverse effects.
	Timely assessment of response to high dose intravenous steroids and withdrawal of steroid treatment in favour of other therapies for those with inadequate response.
(3) Patient-centred care	Availability of good quality information about TED, its usual course, likely outcomes and potential treatments, complemented by high quality written information and access to patient-led organisations.
	Formulation of personalized management plans following multidisciplinary discussion.
	Good communication between the clinical team and the patient.
	Patient engagement with the decision process about management of TED.
	Use of validated tools to assess the impact of TED on their quality of life, like the GO-QOL.
(4) Timely	Patients with sight-threatening TED (dysthyroid optic neuropathy resulting in significant reduction in visual acuity, corneal breakdown with impending or established infection, globe subluxation) should be treated urgently within 2 weeks.
	Patients with moderately to severe, active TED should be offered treatment within a six weeks from presentation.
	Multiple surgical treatments in patients requiring complex rehabilitative surgery, should follow the sequence: orbital decompression/eye muscle surgery/lid surgery.
(5) Efficient	Referral pathways from primary to secondary and tertiary care, should be well defined and seamless.
(6) Equitable	All patients should have access to excellent treatment.