Predictive Factors for Changes in Quality of Life after Steroid Treatment for Active Moderate-to-Severe Graves' Orbitopathy: A Prospective Trial

Abstract

Objectives: To investigate the predictive factors for changes in the quality of life (GO-QoL) of patients with Graves' orbitopathy (GO) prior to and after specific treatment.

Methods: A prospective follow-up study was conducted at an academic tertiary referral orbital center with a joint thyroid-eye clinic on 100 consecutive patients with GO. Before and after the standard 12-week course of weekly intravenous methylprednisolone (cumulative dose 4.5 g), the GO-QoL questionnaire provided by the European Group on Graves' Orbitopathy (EUGOGO) was completed. Endocrine and ophthalmic assessments were performed at each visit.

Results: All patients were biochemically euthyroid and untreated for GO at baseline and presented with active and moderate-to-severe disease. Both GO-QoL subscales (visual functioning [VF] and appearance [AP]) significantly increased after immunosuppressive therapy and showed a sustained improvement for 6 months. At baseline, demographic variables (sex, age, and smoking) influenced QoL in the stepwise linear regression (p < 0.01, adjusted R ² = 0.24 for VF and p < 0.01, adjusted R ² = 0.21 for AP). In contrast, 6 months after treatment, the improved QoL was now exclusively associated with ophthalmic parameters (p < 0.01, adjusted R ² = 0.47 for VF; p < 0.01, adjusted R ² = 0.23 for AP).

Conclusions: Predictive factors for GO-QoL differed not only between the 2 subscales but also before and after the first treatment of GO.

Keywords: Graves' orbitopathy; Multivariate analysis; Predictive factors; Prospective; Quality of life.

Fig. 1

Serial GO-QoL score and its subscales. a Mean GO-QoL scores. b Visual functioning subscale. c Appearance subscale. The p values shown referred to the comparisons with week 0. The error bars represented the mean ± SD of mean QoL scores or subscales. The detailed scores and the statistical comparisons between different time points are shown in online supplementary Table 3. * Statistically significant difference when comparing with week 0. ^ Statistically significant difference between weeks 12 and 36.

Fig. 2

a Negative correlation between age and visual functioning subscale. b Positive correlation between age and appearance subscale.