August 01, 2017
2 min read

Warning cards prompt telephone contact, new diagnoses of Grave’s orbitopathy

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A program for patients with Graves’ disease that included the distribution of “warning cards” on the signs and symptoms of Graves’ orbitopathy resulted in early detection of the condition in 45% of cases without an excess burden of telephone contacts, according to study findings published in Clinical Endocrinology.

“At any one time, there is a group of patients with [Grave’s disease] attending endocrine clinics with subtle symptoms and signs of [Grave’s orbitopathy], which are easily overlooked,” Anna Mitchell, MBBS, MRes, MRCP, PhD, of the department of endocrinology, Royal Victoria Infirmary, Newcastle Hospitals NHS Foundation Trust, and colleagues wrote. “A number of inexpensive interventions have been demonstrated to be safe and effective in the management of individuals with mild, active [Grave’s orbitopathy], making early identification of cases worthwhile.”

Mitchell and colleagues analyzed data from 160 patients with Grave’s disease (defined as hyperthyroidism or subclinical hyperthyroidism and smooth, symmetrical goiter or positive thyroid-stimulating hormone receptor antibodies) who received credit-card-sized Grave’s orbitopathy warning cards between December 2014 and March 2015. Patients were instructed to read the cards, which included a list of common symptoms of Grave’s orbitopathy (redness in eyes; bags under the eyes; pain behind eyes; sensitivity to light; blurred or double vision) and a local telephone number for patients who develop eye symptoms (mean age, 47 years; 77% women; median number of years since diagnosis, 2 years). Cards included unique serial numbers that could be matched to patients. Researchers reviewed medical records of all card recipients after 12 months to determine whether any had developed Grave’s orbitopathy, but had not contacted the telephone number listed on the cards. Patients were asked to complete a 9-item questionnaire about the cards, either online or by regular mail, in June 2016.

Over 12 months, researchers documented 10 telephone calls from nine patients; 6% of cards distributed in telephone contact. Nine of the 10 calls occurred within the first 3 months of follow-up; all calls related directly to symptoms. Eight patients were offered a clinic review, of whom six were seen in an endocrinology clinic, and two were seen in a multidisciplinary thyroid eye clinic. Four diagnoses of Grave’s orbitopathy occurred.

In a review at 12 months, researchers found that five patients developed Grave’s orbitopathy, but had not called the telephone number listed on the cards.

In a survey completed 3 months after the conclusion of the study, 49 patients (31%) responded; of those 45 remembered receiving a card; 89% said the card was useful, and 98% said they understood the purpose of the card.

“[Graves’ orbitopathy] early warning cards can be used to alert both patients with [Graves’ orbitopathy] and the physicians caring for these individuals to the risk of [Graves’ orbitopathy] and are well received by patients,” the researchers wrote. “They do not result in an excess burden of telephone contacts and resulted in early detection of [Graves’ orbitopathy] in 45% of cases. Regular reinforcement of risk awareness may result in more cases being detected early. [Graves’ orbitopathy] early warning cards can be successfully used to fast-track patients with [Graves’ orbitopathy] who develop ocular symptoms to receive an earlier specialist assessment for [Graves’ orbitopathy], and potentially an earlier diagnosis and treatment, and represent a simple and cost-effective intervention.” – by Regina Schaffer

Disclosures: Endocrine Today was unable to determine relevant financial disclosures at time of publication.