Graves' Ophthalmopathy: Epidemiology and Natural History

Abstract

Graves' ophthalmopathy (GO) is an autoimmune disorder of the orbit that is clinically relevant in 25-50% of patients with Graves' disease and 2% of patients with chronic thyroiditis. The age-adjusted annual incidence of clinically relevant GO is 16 per 100,000 population in women and 2.9 in men. At the onset of ophthalmopathy, 80-90% of patients have hyperthyroidism, with the rest having euthyroidism or hypothyroidism. The natural history of GO consists of two phases: an active inflammatory phase and a static phase. Antiinflammatory therapy is indicated for the first phase of GO. Approximately 5% of patients experience late reactivation of GO. Asians appear to have less severe manifestations, with milder orbital edema, proptosis and muscle restriction. Genetic, anatomic and environmental factors influence the development of GO. Aging, thyroid dysfunction, thyroid stimulating hormone (TSH) receptor antibodies, smoking and radioiodine treatment for hyperthyroidism also influence the development and course of GO.

Prevalence, Phenotype, and Psychosocial Well-Being in Euthyroid/Hypothyroid Thyroid-Associated Orbitopathy

“…The age-adjusted annual incidence of clinically relevant TAO is 16 per 100,000 individuals in women and 2.9 per 100,000 in men (3). Two age peaks of incidence are observed in the fifth and seventh decades of life with slight differences between women and men (4).…”

“…The disease is more frequent in women than in men (4). At the onset of TAO, 80-90% of patients are hyperthyroid, the remaining being euthyroid or hypothyroid (3). The prevalence of TAO in primarily euthyroid and primarily hypothyroid patients ranges between 1.6% and 8.6% (5)(6)(7)(8)(9).…”

Neutrophil-to-lymphocyte ratio in thyroid ophthalmopathy

“…While the orbital infi ltration is generally mild to moderate, severe ophthalmopathy can be seen in 3-5 % of all cases (3). Hyperthyroidism is commonly accompanied with TO but in some cases hypothyroidism develops due to Hashimoto's disease and euthyroidism can occur (4).…”

Orbitopatía tiroidea, una visión global con atención especial al papel de la radioterapia

“…Suele iniciarse entre la tercera y cuarta décadas de vida. Su presentación clínica puede ser más severa en ancianos y en hombres, y más leve en asiáticos 2,3 .…”

“…La mayor parte de las veces este trastorno sigue una evolución benigna e independiente del hipertiroidismo, e incluso en los casos moderados-severos puede autolimitarse con el tiempo, persistiendo únicamente cierto grado de exoftalmos y oftalmoplejía 2,9 . A hora de tomar decisiones terapéuti-cas se debe tener en consideración que el mayor pico de actividad se registra entre los 13 y 24 meses tras su inicio; posteriormente la mayoría de pacientes (hasta un 80-90%) pueden mejorar o permanecer estables 11 .…”