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ОглавлениеPreface to the Second, Revised Edition
The first edition of Graves’ Orbitopathy: A Multidisciplinary Approach was very well received. We are grateful for the many pieces of positive feedback and constructive comments from our readers. The multidisciplinary approach and the question-and-answer format appear to be a highly successful formula, warranting a second edition of the book within 3 years of the first.
All chapters have been thoroughly updated, and it is gratifying to see how much progress has been made not only in better understanding the pathogenesis of Graves’ orbitopathy, but also in its treatment. The EUGOGO consensus statement on the management of Graves’ orbitopathy has been accepted worldwide as a useful guideline and is now fully incorporated in the text. Two new chapters have been added: one describing the socioeconomic impact of the disease and the other outlining the Amsterdam Declaration on Graves’ orbitopathy. This declaration, aiming to improve outcomes for thyroid eye disease, was signed by 82 national and international organizations in the field of thyroidology and ophthalmology at the International Symposium on Graves’ Orbitopathy held in October 2009 in Amsterdam on the occasion of the 10th anniversary of EUGOGO.
We hope the second edition will again contribute to improvements in the quality of care delivered by health professionals to patients with Graves’ orbitopathy.
On behalf of EUGOGO,
Wilmar M. Wiersinga, Editor
George J. Kahaly, Co-Editor
Amsterdam and Mainz, June 2010
We are very pleased to present Graves’ Orbitopathy: A Multidisciplinary Approach.
The title of the book is a reflection of our opinion that real progress can be made in understanding thyroid eye disease and in improving the outcome of the disfiguring and often invalidating eye changes associated with Graves’ orbitopathy only if specialists of various disciplines work closely together. In other words, we favour a multidisciplinary approach in which internists/endocrinologists, ophthalmologists/orbital surgeons and basic scientists combine their forces. This has been the philosophy since the foundation of EUGOGO, the European Group on Graves’ Orbitopathy, in 1999. The group is currently composed of 13 centres in 8 European countries (Belgium, France, Germany, Greece, Italy, the Netherlands, Switzerland, and the United Kingdom), and, in accordance with our philosophy, each centre is represented by specialists in internal medicine and ophthalmology. A further requirement of EUGOGO membership is that each participating centre must have combined thyroid-eye clinics in which the patient can be seen simultaneously by physicians from both disciplines. It is gratifying to note that the number of combined thyroid-eye clinics has been increasing slowly but steadily throughout Europe over the last decade, thereby enhancing the quality of patient care.
EUGOGO meets twice a year, and we have had many lengthy and at times heated discussions on how to assess the eye changes in a most objective manner and what the best treatment should be. It has taken us several years to reach an acceptable degree of agreement among ourselves, again illustrating the many pitfalls in the management of Graves’ orbitopathy as well as the importance of using a multidisciplinary approach. Only then could we embark on prospective clinical trials (the size of the group allows completion of clinical studies in a much shorter time than possible for each individual centre), on teaching courses how to investigate and treat the patient with Graves’ orbitopathy (so far 3 courses have been held – Thessaloniki 2005, Pisa 2006, and Mainz 2007), and on papers in scientific journals describing the outcome of our studies and recommendations on disease management.
The present book reflects our current thinking on Graves’ orbitopathy: all authors are EUGOGO members. The internal consistency between chapters is the result of our ongoing discussions during the annual EUGOGO meetings. The outline of the book is unusual by its choosing the question-and-answer format. The purpose is to enable the book to be also used as a quick reference source for the practising physician confronted with an ordinary or extraordinary management question: most likely the answer can be found in one of the 194 questions asked in this book. We do not apologize for some overlap between chapters (especially on smoking and thyroid treatment), because these issues are relevant to many aspects of Graves’ orbitopathy and it facilitates fast retrieval of the information you are looking for. Topics such as unilateral eye disease, childhood Graves’ orbitopathy, and disease-specific quality-of-life assessment which are not easily found elsewhere receive the attention they deserve. The editors welcome feedback from the readership: please send your comments to us, also on how future editions could be improved. You may also consult the EUGOGO website (www.eugogo.eu).
We would like to thank the patients with Graves’ orbitopathy who cooperated in our endeavours to better understand their disease. We also thank S. Karger AG, Medical and Scientific Publishers, for their efforts to edit, produce, and publish the book within a very short time. Last but not least, we are grateful to the authors for their excellent contributions. It again proves how much can be accomplished by a group of dedicated people.
Wilmar M. Wiersinga, President EUGOGO, Editor
George J. Kahaly, Treasurer EUGOGO, Co-Editor
Amsterdam and Mainz, June 2007
