BackgroundGraves’ orbitopathy (GO) is subject to epidemiological and care-related changes. Aim of the survey was to identify trends in presentation of GO to the European Group On Graves’ Orbitopathy (EUGOGO) tertiary referral centres and initial management over time.MethodsProspective observational multicentre study. All new referrals with diagnosis of GO within September–December 2019 were included. Clinical and demographic characteristics, referral timelines and initial therapeutic decisions were recorded. Data were compared with a similar EUGOGO survey performed in 2012.ResultsBesides age (mean age: 50.5±13 years vs 47.7±14 years; p 0.007), demographic characteristics of 432 patients studied in 2019 were similar to those in 2012. In 2019, there was a decrease of severe cases (9.8% vs 14.9; p<0.001), but no significant change in proportion of active cases (41.3% vs 36.6%; p 0.217). After first diagnosis of GO, median referral time to an EUGOGO tertiary centre was shorter (2 (0–350) vs 6 (0–552) months; p<0.001) in 2019. At the time of first visit, more patients were already on antithyroid medications (80.2% vs 45.0%; p<0.001) or selenium (22.3% vs 3.0%; p<0.001). In 2019, the initial management plans for GO were similar to 2012, except for lid surgery (2.4% vs 13.9%; p<0.001) and prescription of selenium (28.5% vs 21.0%; p 0.027).ConclusionGO patients are referred to tertiary EUGOGO centres in a less severe stage of the disease than before. We speculate that this might be linked to a broader awareness of the disease and faster and adequate delivered treatment.

Graves orbitopathy (GO) is an autoimmune disorder of the retrobulbar tissue 1 probably initiated by autoreactive T lymphocytes which trigger a cascade of events including secretion of cytokines, 2 simulating proliferation of orbital fibroblastas, expansion of adipose tissue and secretion of glycosaminoglycans by the orbital fibroblasts. Therefore, immunosuppressants and anti-inflammatory agents are the treatment of choice for moderate-to-severe-and active GO. 3,4 Although different immunosuppressants including biological agents

Background / Aim. Although subclinical hypothyroidism (SCH) is frequently a biochemical diagnosis, some symptoms and signs of overt disease may be present, influencing our decision to start the treatment with levothyroxine (LT4). The aim of this study was to examine the effect a 3-month LT4 treatment on clinical presentation and quality of life in symptomatic SCH with TSH < 10 mIU/L. We also considered whether treatment discontinuation additionally improves reliability of these findings. Methods. Clinical parameters (disease-specific score) and quality of life (Short Form 36 questionnaire) were measured in 35 patients with persistent symptomatic SCH before the intervention (TSH 7.0±2.1 mIU/L), 3 months after the euthyroid state had been achieved and 3 months after cessation of LT4 substitution. Results. The median of Zulewski index significantly decreased after the treatment with LT4: 5.0 (4.0-7.0) vs 3.0 (2.0-5.0) (p <0.001) representing a reduction of symptoms. The most common ailments before treatment were dry skin (71.4%), hoarseness (65.7%) and rough skin (54.3 %). After the treatment, there was a significant reduction in the frequency of constipation (p=0.004), dry skin (p=0.022), hoarseness (p=0.002), decreased sweating (p=0.006), and delayed Achilles reflex (p=0.002). Quality of life was not changed significantly after LT4 treatment. In the group of 18 patients who discontinued the treatment, many symptoms and signs reappeared with the increasing of TSH (6.8±1.1 mIU/L): periorbital edema, constipation, weight gain, decreased sweating, slow motion and delayed Achilles reflex. The median of the Żulewski index after discontinuation of LT4 was 6.0 (4.0-9.0) (p = 0.010). Also, there was a statistically significant reduction in the general health score, vitality, role emotional and mental health scores. Conclusions. Clinical score based on symptoms and signs is a sensitive and reproducible test for objective estimation of LT4 treatment effects in symptomatic SCH patients with TSH <10 mIU/L and supports individually adjusted treatment. Symptomatic SCH is not necessarily associated with a quality of life impairment that may be significantly improved by thyroxine treatment. Changes in general health, vitality, mental health and emotional role after LT4 cessation suggest that some aspects of life quality can be affected by subtle variations in thyroxine availability.

Introduction/Aim. Hypothyroidism is a common disease and treatment with levothyroxine (LT4) is effective. However, variations in management are frequent. The aim of this study was to identify practices and attitudes of Serbian physicians relating to the treatment of hypothyroidism. Methods. An anonymized questionnaire was distributed electronically to members of the Serbian Thyroid Society, Serbian Association of Endocrine Surgeons, and Section for Endocrinology of the Serbian Medical Society. Results. Out of 170 invitations, 99 responses were received. LT4 was the first choice for the treatment of hypothyroidism in 90% of patients. After starting LT4 replacement therapy most respondents would recheck thyroid-stimulating hormone (TSH) in 4-6 weeks (n=51, 62%) and in 8 weeks (n=29, 35%). Sixty-one percent of respondents (n=60) indicated that they would consider treating euthyroid patients with LT4, the commonest indication being female infertility with high levels of thyroid antibodies (54%, n=50). More than half respondents (58%, n=45) would recommend combined LT4+LT3 therapy for patients on LT4 with normal serum TSH who still complain of symptoms of hypothyroidism. Fifty-three per cent (n=41/77), reported that the frequency of patients with normal serum TSH who still complain of hypothyroid symptoms is less than 5%. Conclusions. LT4 was the first choice of therapy for the treatment of hypothyroid patients, whereas LT3+LT4 combination treatment is considered in patients with persistent symptoms of hypothyroidism despite normalization of TSH. The most common indication for thyroid hormone treatment in euthyroid patients was female infertility with high levels of thyroid antibodies. Alternative LT4 formulations like liquid solution or soft-gel capsules -formulations presently not available in our country, were largely reserved for specific conditions (interfering drugs, malabsorption, inability to take LT4 in the fasting state, unexplained poor biochemical control of hypothyroidism).