Does Graves' Orbitopathy Ever Disappear? Answers to an Old Question

Abstract

Objectives: There is a general belief that Graves' orbitopathy (GO) is a "chronic" disease, namely that patients' eyes do not return to how they were before GO appeared. Here, we investigate this issue from both the patient's and the physician's point of view.

Study design: We studied the disappearance of GO, regardless of treatment, in all consecutive patients with a GO history of at least 10 years who came for a follow-up visit over a period of 5 years. Patients underwent an ophthalmological examination and were asked to answer a questionnaire on self-perception related to GO.

Results: We studied 99 consecutive patients with a GO duration ≥10 years. Between the first and the last observation, patients received several types of treatment for their thyroid disease and/or for GO. At the end of follow-up, GO was considered disappeared based on objective criteria in 8 patients (∼8%) and based on subjective criteria in 24 patients (∼24%). When we considered both subjective and objective criteria, only 2 patients (∼2%) had all criteria fulfilled and could be considered as GO-free.

Conclusions: GO is a chronic disease in the vast majority of patients. Even after a very long time since its onset, complete disappearance is rare, although a minority of patients believe they do not have GO anymore and an even lower proportion do not have relevant GO signs. Our findings have obvious implications in patient management and counseling.

Keywords: Autoimmunity; Graves' disease; Graves' orbitopathy; Thyroid.

Fig. 1.

Distribution of exophthalmometry (a) and clinical activity score (b) values at the last observation in 99 patients with long-standing (≥10 years) Graves' orbitopathy.

Fig. 2.

Prevalence of Graves' orbitopathy (GO) disappearance based on objective and subjective criteria or both in 99 patients with long-standing (≥10 years) eye disease. Objective criteria: (i) exophthalmos ≤19 mm in men and ≤17 mm in women; (ii) clinical activity score ≤1/7 points; (iii) absence of diplopia; (iv) normal visual acuity, or reduction of visual acuity unrelated to GO; (v) normal corneal status; and (vi) no GO-related alterations of the fundi. Subjective criteria (questionnaire): (i) perception of both eyes identical to the way they were before GO appeared; (ii) perception of both eyes as normal; (iii) no eye-related limitations in daily activities; and (iv) no eye-related limitations in social life.