Table 9.
Research Gaps in the Management of Thyroid Eye Disease
| Identifying TED or those at risk for TED |
| Are there reliable biomarkers to predict the development of TED in patients with newly diagnosed GD? |
| Are there reliable biomarkers to assess TED activity more accurately than CAS? |
| Is there a simple clinical screening tool to identify patients with early TED? |
| Is there a simple and easy screening tool that patients with GD can use to self-diagnose TED early? |
| Is race a risk factor for TED? |
| What are the underlying mechanisms whereby radioactive iodine increases the risk of TED? |
| Assessment of patients with TED |
| How does vision, inflammation, strabismus, appearance compare with CAS for reproducibility and for predicting response to treatment? |
| Are there more objective and reproducible methods than clinical examination to document the features of TED (e.g., photogrammetry)? |
| How do we best utilize QOL measures (e.g., GO-QOL, TED QOL) to guide everyday clinical practice? |
| Treatment of mild TED |
| Is selenium useful in selenium sufficient areas? |
| Is elevation of head of bed of any value in patients with TED? |
| Treatment of moderate-to-severe TED |
| How does TEP compare with IVGC therapy in head-to-head comparison studies? |
| What is the durability of clinical response after TEP therapy? |
| What is the optimal dosing and duration of TEP therapy? |
| Is TEP therapy cost-effective at current prices? |
| What is the effectiveness of TEP therapy for inactive and/or protracted TED (>12 months duration) |
| What is the role of mycophenolate mofetil? |
| Is there a role for thyrotropin receptor blocking agents in the management of TED? |
| Is combined treatment of IVGC and RT more efficacious than IVGC alone? |
| What is the efficacy and optimal dosing of RTX? |
| What are the most relevant outcome measures in clinical trials for TED? |
| What is the impact of medical therapies on subsequent surgical management? |
| Is selenium helpful in moderate-to-mild TED? |
| Is there a role for statins? |
| Treatment of recurrent or refractory TED |
| What are the most effective treatment choices for recurrent TED? |
| Pathogenesis of TED |
| What components of tobacco smoke contribute to TED? |
| How effective is smoking cessation? |
| What is and how do we separate “congestive” TED from active TED? |
| Health care models for the management of TED |
| What is the most clinically effective and cost-effective specialty TED care model? |
| What is the impact of current drug costs, affordability, and limited global availability on health disparities in TED? |
| Ophthalmology-specific research |
| What is the role of chin-up positioned eye assessment in TED (to eliminate gaze-dependent ocular hypertension and optic neuropathy in restrictive strabismus)? |
| Is the Gorman diplopia score an optimal metric of ocular motility impairment in routine clinical practice and in clinical trials? |
| What is the role of RT/GC vs. GC alone in treating cases of established DON and allowing avoidance of surgery? |
GD, Graves' disease; QOL, quality of life.