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Prevalence and natural history of Graves’ orbitopathy in the XXI century

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Abstract

Graves’ orbitopathy (GO) is an autoimmune disorder and the main extrathyroidal expression of Graves’ disease. There is a spectrum of ocular involvement in Graves’ disease, from complete absence of symptoms and signs to sight-threatening conditions. The prevalence of GO varies in different published series of Graves’ patients, due to confounding factors (new diagnosis vs long-lasting disease, way of defining and assessing ocular involvement, treatment of hyperthyroidism with potentially GO-modifying treatments, such as radioiodine). Recent studies, however, suggest that most Graves’ patients have mild or no GO at presentation, while moderate-to-severe GO is rare, and sight-threatening GO (mostly due to dysthyroid optic neuropathy) is exceptional in non-tertiary referral centers. The natural course of GO is incompletely defined, particularly in patients with moderate-to-severe GO, because these patients require prompt and disease-modifying therapies for orbital disease. In patients with mild GO at presentation, progression to severe forms is rare, while partial or complete remission is frequent. Progression of pre-existing GO or de novo occurrence of GO is more likely in smokers. There seems to be a trend towards a decline in progression of GO, possibly due to a better control of risk factors (cigarette smoking, thyroid dysfunction, etc.) and a closer interaction between endocrinologists and ophthalmologists allowing an improved integrated management of thyroid and orbital disease.

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Authors and Affiliations

  1. Department of Clinical & Experimental Medicine, University of Insubria, Endocrine Unit, Ospedale di Circolo, Viale Borri, 57, 21100, Varese, Italy

    E. Piantanida, M. L. Tanda, A. Lai, L. Sassi & L. Bartalena MD

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  1. E. Piantanida
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  2. M. L. Tanda
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  3. A. Lai
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  4. L. Sassi
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Correspondence to L. Bartalena MD.

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Piantanida, E., Tanda, M.L., Lai, A. et al. Prevalence and natural history of Graves’ orbitopathy in the XXI century. J Endocrinol Invest 36, 444–449 (2013). https://doi.org/10.3275/8937

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