Clinical assessment of patients with Graves’ orbitopathy: the European Group on Graves’ Orbitopathy recommendations to generalists, specialists and clinical researchers

The European Group on Graves’ Orbitopathy(EUGOGO) was established in order to promotebetter clinical care of patients with Graves’ orbito-pathy (GO) (1, 2) and to facilitate research in thisdisease. EUGOGO believes that patients with GOshould be managed in multidisciplinary clinics withinput from endocrinologists and ophthalmologists,who have an interest and experience in managingthis disease (3). Although the expertise of theclinicians is critical and the setting perhaps less so,evidence from other clinical disciplines wouldsuggest that a dedicated multidisciplinary clinicresultsinbetteroutcomes(4, 5).EUGOGO isaware that many patients with GO in Europenever reach specialist centres or are referred toolate to benefit from treatments (6), which results ina suboptimal outcome and sometimes loss of vision.EUGOGO recommends that primary care physicians,general practitioners, general internists and special-ists, who have no particular expertise in managingsuch patients, should refer all but the mildest casesof GO to tertiary centres with established multi-disciplinary clinics for further assessment andmanagement. Selecting which patients should bereferred and with what degree of urgency, ischallenging for the generalist. EUGOGO proposes asimple clinical tool, which can be completed in lessthan 5 minutes by any medically qualified personand can help to identify patients who merit urgentor routine referral (Table 1).