Projects

Ongoing studies and projects in the Thyroid Eye Research Program at Mayo Clinic are aimed at better understanding the prevalence and mechanisms of thyroid eye disease (Graves' disease), assessing patients' treatment needs, and testing new treatments in clinical trials. This work includes:

• Therapeutic intervention clinical trials. Researchers are conducting and creating therapeutic intervention clinical trials.
  • The program is conducting a multicenter clinical trial to test how a drug that decreases levels of the antibodies that attach to the thyroid-stimulating hormone receptor (TSHr) — an essential component of the disease mechanism — may benefit patients with thyroid eye disease.
  • Researchers are also collaborating with the manufacturer of teprotumumab in planning clinical trials that would test this drug in different groups of patients with thyroid eye disease than those currently evaluated.
• TSHr antibody assay evaluation. The Thyroid Eye Disease Research Program is testing a new assay for the more precise measurement of TSHr antibodies.
• Epidemiological research. Building on previous work using the Rochester Epidemiology Project, researchers are improving knowledge about the incidence of new cases and prevalence of total cases of thyroid eye disease a year.
• Tissue biobanking. Mayo Clinic is developing a tissue biobank to support further research on the mechanisms of thyroid eye disease by collecting tissue from patient volunteers undergoing orbital decompression.
• Guidelines for surgery. Investigators are evaluating what degree of eye asymmetry from bulging (proptosis) is recognizable to the general public in order to determine which patients may benefit most from surgery.

Future research

The program is planning several research efforts aimed at improving care and quality of life for people with thyroid eye disease, including studies on:

• Quality of life. Researchers aim to expand the use of quality-of-life scores in understanding the burden of disease in patients with thyroid eye disease.
• Selenium treatment. The program plans to evaluate the benefits of using selenium to treat patients with thyroid eye disease in the United States, as the only available data come from Europe, where selenium sufficiency levels are significantly lower.
• Industry collaborations. The Thyroid Eye Disease Research Program is planning to collaborate with manufacturers that are developing drugs to further block TSHr or TSHr antibodies.

Research background

Mayo Clinic has been at the forefront of clinical research on thyroid eye disease for the last three decades, providing a strong foundation for the Thyroid Eye Disease Research Program's current and future field-leading work. Previous research highlights include:

• Epidemiological research. Researchers described the epidemiology of thyroid eye disease using the Rochester Epidemiology Project.

  Related publication:

  • Bartley GB, Fatourechi V, Kadrmas EF, Jacobsen SJ, Ilstrup DM, Garrity JA, Gorman CA. The incidence of Graves' ophthalmopathy in Olmsted County, Minnesota. American Journal of Ophthalmology. 1995; doi:10.1016/s0002-9394(14)72666-2.

• Evaluation of radiation therapy. Mayo Clinic investigators have explored the benefit — or lack thereof — of external radiation to the orbits for patients with thyroid eye disease.

  Related publication:

  • Gorman CA, Garrity JA, Fatourechi V, Bahn RS, Petersen IA, Stafford SL, Earle JD, Forbes GS, Kline RW, Bergstralh EJ, Offord KP, Rademacher DM, Stanley NM, Bartley GB. A prospective, randomized, double-blind, placebo-controlled study of orbital radiotherapy for Graves' ophthalmopathy. Ophthalmology. 2020; doi:10.1016/j.ophtha.2020.01.031.

• Evaluation of drug treatments. Researchers have tested the potential benefits of octreotide and rituximab for the treatment of active thyroid eye disease.

  Related publications:

  • Stan MN, Garrity JA, Bradley EA, Woog JJ, Bahn MM, Brennan MD, Bryant SC, Achenbach SJ, Bahn RS. Randomized, double-blind, placebo-controlled trial of long-acting release octreotide for treatment of Graves' ophthalmopathy. The Journal of Clinical Endocrinology & Metabolism. 2006; doi:10.1210/jc.2006-1105.
  • Stan MN, Garrity JA, Carranza Leon BG, Prabin T, Bradley EA, Bahn RS. Randomized controlled trial of rituximab in patients with Graves' orbitopathy. The Journal of Clinical Endocrinology & Metabolism. 2015; doi:10.1210/jc.2014-2572.
• Discovery research. Mayo Clinic has conducted laboratory research on the mechanism of thyroid eye disease by exploring tissue cultures of orbital fibroblasts.