Addressing Education Gaps in Thyroid Eye Disease With Sonalika Khachikian, MD

On September 10, 2025, HCPLive sat down with Sonalika Khachikian, MD, an endocrinologist at Monument Health, to discuss recent news from the Endocrinology Society’s 2025 Congress in San Francisco, California. During this conference, Khachikian discovered a gap in knowledge surrounding thyroid eye disease (TED) among clinicians.

TED is an autoimmune inflammatory disorder primarily affecting the orbit, leading to significant ocular morbidity. Diagnosis is typically characterized by eyelid retraction with abnormal thyroid function, exophthalmos, optic nerve dysfunction, or extraocular muscle involvement. Roughly 90% of TED cases are associated with Graves’ disease, requiring a multi-specialty collaboration between ophthalmologists, endocrinologists, and otolaryngologists for treatment.1

Despite its relative rarity, affecting roughly 16 in 100,000 women and 2.9 in 100,000 men, TED is the most common inflammatory orbital disorder. Symptoms can cause significant facial disfigurement and visual disability. It is relatively mild in 77% of all cases, moderate-to-severe in 22% of cases, and potentially sight-threatening in only 1% of patients.1,2

During the conference, Khachikian held the “TEDucation Challenge”, described as a rapid-fire trivia game centering around TED. Questions bridged various key TED categories, but all 22 participants failed to correctly answer the following question: what does the ATA/ETA consensus statement recommend for endocrinologists that differs from ophthalmologists?

The correct answer to this question was “screen all Graves’ disease patients for TED.” All respondents answered incorrectly, indicating an ongoing need for education in TED management. It also suggests that TED may frequently be missed in clinical practice, as it can easily go unnoticed or undiagnosed without routine screening.

“I think part of the trouble lies in the fact that most people don’t always see their ophthalmologists,” Khachikian told HCPLive. “They go to see their eye doctor for specific reasons, and they don’t always know that there’s a link between their eye symptoms and their thyroid. This is why I think they are talking to endocrinologists and having an endocrinologist empower their patients.”

In light of the knowledge gap, Khachikian advised endocrinologists to take a more active stance in screening for TED. She suggested involving eye-related questions in standard thyroid examination, not only to more reliably catch the disease before it’s too late, but also to help make the connection for patients.

“What I typically do in my offices, I go through and do my review assistance for their thyroid, and then I ask them if they’re having troubles with their eyes, if they’re noticing any grittiness, if they’re noticing any dryness, any sensitivity,” Khachikian said. “If I don’t make that link for them, sometimes they don’t know that that’s what’s going on.”

Ultimately, Khachikian called for clinicians to take a more multidisciplinary, involved role in treating TED. The numerous disciplines involved in diagnosing and treating the disease can lead to concerns about overstepping specialties, but Khachikian encourages specialists to work together in addressing the condition.

“Let’s look at this and let’s see what we can do, or where we can fit,” she said. “Oftentimes as an endocrinologist, I thought, with TED, am I stepping out of my area? But the more I think about it, I came to look at it as our job to empower and educate our patients. So it’s time to get on the same page.”

References

1. Szelog J, Swanson H, Sniegowski MC, Lyon DB. Thyroid Eye Disease. Mo Med. 2022;119(4):343-350.

2. Wiersinga WM, Eckstein AK, Žarković M. Thyroid eye disease (Graves' orbitopathy): clinical presentation, epidemiology, pathogenesis, and management. Lancet Diabetes Endocrinol. 2025;13(7):600-614. doi:10.1016/S2213-8587(25)00066-X