Integrating evidence, consensus, and real-world practice in thyroid eye disease: A collaborative research agenda from Colombia

Abstract

Thyroid eye disease (TED), also known as Graves’ orbitopathy, represents a paradigmatic clinical challenge within the spectrum of rare autoimmune diseases. Its relatively low incidence in moderate-to-severe forms, marked clinical heterogeneity, and the complexity of therapeutic decision-making limit the generation of robust and broadly applicable evidence across healthcare settings. In this context, the development of structured, context-adapted, and progressively integrated scientific tools becomes a priority.

This work is the result of a sustained collaborative effort among members of the Colombian Association of Endocrinology, Diabetes, and Metabolism (ACE, by its Spanish acronym), together with ophthalmologists and endocrinologists, aimed at strengthening the scientific framework available for the study and management of TED in our setting. Importantly, this initiative does not represent an isolated academic product, but rather forms part of a structured research strategy that integrates evidence synthesis, formal consensus, and real-world data generation.

As a foundational step, the group conducted a comprehensive systematic review that synthesizes the current therapeutic landscape for active moderate-to-severe TED. This work consolidates available evidence on glucocorticoids, biologic therapies, and immunosuppressive agents, confirming consistent patterns—such as the central role of intravenous glucocorticoids—while also identifying areas of uncertainty, particularly regarding the comparative effectiveness of emerging therapies. Moreover, it highlights key limitations in the field, including heterogeneity in reported outcomes, the lack of head-to-head trials, and the underrepresentation of Latin American populations.