by: Dr. Petros Perros

The Greek passengers cheered and applauded as the plane touched down at Thessaloniki airport. This has happened ever since I can remember from my student days. It must be that overwhelming emotion of safely reaching home. I have used almost every other means of transport to reach the same destination but this reaction is only provoked by the screeching of heavy tyres on tarmac and the din of reverse thrust. I rather think it is the relief of escaping the fate of Icarus, a deeply seated phobia in the soul of most Greeks.

Familiar figures beckon me in the arrival lounge and I am immediately surrounded by the TED trio of Sally Mitchell, John Borthwick and Ann Rigby-Jones, with whom I had shared the same flight. Subconsciously I look at my watch and make a note of the time. Forty-five seconds later, Sally has beaten her own record. She has extracted a promise from me to write a report on the meeting for the TED newsletter and, as it has turned out, for the TFI newsletter as well.

The success of a meeting depends among other things on the selection of speakers and the organizational skill of the hosts. I admit having had some misgivings about the latter as organization is not a national trait that we Greeks are renowned for. But my fears proved to be entirely unfounded. A year of preparation and tons of Herculean hard work by Professor Krassas and his committee ensured that everything went smoothly. To top it off, we were graced by a superb location at the foot of Mount Olympus, the profuse hospitality of our hosts and the high scientific quality of the presentations.

So what is new in the field? Firstly, the impression that research in this disease is becoming more rigorous. There is less anecdote and more science than ever before. Basic scientific research is revealing more about the immunological processes that lead to the disease. There is increasing evidence that molecules closely related to those present in the thyroid gland (TSH receptors) are also found in the eye and are targets of the immune system. The chemical messengers that mediate the inflammatory response in the eye (cytokines) are beginning to be characterised, leading to opportunities for the use of new drugs in treatment. A new promising model of the disease was described, which could provide some answers to important questions.

Several delegates confirmed the view that smoking makes the eye disease worse. Patients who continue to smoke have a worse response to some of the conventional treatments for thyroid eye disease (eg radiotherapy).

The need to distinguish between disease severity and disease activity was discussed extensively. The disease can be severe (eg extreme protrusion of the eyes) but inactive (no signs of inflammation). The choice of treatment depends on these two parameters. For instance, there is no point in treating inactive disease with anti-inflammatory medication but corrective surgery may be indicated. Simple though it seems, quantifying disease activity accurately and objectively is extremely difficult. New ways of measuring it are emerging, however, and include octreotide scanning of the eyes, MRI and measurement of certain chemicals in the blood or urine.

Preliminary results indicate that the drugs octreotide and lanreotide can be effective in thyroid eye disease and are relatively free of side effects. Unfortunately, they have to be given by injection, are very costly and more data is required before they can be used in clinical practice.

The effect of radioactive iodine (given to treat hyperthyroidism) on the eyes has been debated for some time and was again the subject of heated discussion in the meeting. I have been a sceptic about this effect of radioiodine, but new information generated by Italian colleagues seems to be convincing. Deterioration of the eye disease is usually transient, however, and far less frequent than implied by previous studies. A consensus seemed to emerge from the meeting that radioiodine should be avoided if possible in patients with established active eye disease. The effect of radioiodine on the eyes can be minimised by early thyroxine replacement or steroid treatment.

Corrective surgical techniques can improve the appearance of the eyes enormously but experience and expertise are vital for good results. There was general agreement that more should be offered to patients to improve appearance. This is an area where, I believe, we in the UK lag behind other European countries. Numerous letters to TED by sufferers are a moving testimony to this fact.

The TED delegation featured prominently during the meeting. The joint TED and TFI display stands were constantly surrounded by people picking up brochures and asking for information on patient organizations. One Greek endocrinologist told me he had heard of me, not through publications in medical journals but from my contributions to TED newsletters.

As the plane touched down on a thoroughly wet Heathrow, there were no cheers but then there were hardly any Greek passengers. I sighed with relief and refrained from applauding.

Petros Perros Bsc MBBS MRCP MD,
Consultant Physician/Endocrinologist,
Freeman Hospital, Newcastle upon Tyne

Copyright © 1998 TED Thyroid Eye Disease Association