Endocrine Abstracts

Introduction: The aetiology of Graves’ orbitopathy (GO) is complex and includes genetic and environmental influences. Among potentially controllable risk factors smoking ranks highest. There is strong evidence that smoking cessation benefits patients with GO. The success of secondary prevention strategies depends largely on how the intervention is perceived by patients, especially when it involves lifestyle changes.

Objectives: To determine patient perceptions about the cause of GO.

Methods: Forty consecutive patients (32 female) with GO attending a tertiary referral centre were studied. All patients had previously received information about the detrimental effects of smoking on GO and smokers were counselled about smoking cessation. Participants were questioned using a structured questionnaire about factors, which they felt had caused their eye condition. Median age was 55 years (15–88). Median duration of GO was 2 years (0–38). The worst recorded severity of the eye disease (NOSPECS) was class II: 22.5%, class III: 20%, class IV 32.5%, class VI: 25%. Twenty-six (65%) patients were smokers.

Results: Fifteen patients did not blame anything for their eye disease. Fifteen patients proposed plausible contributors, which included thyroid overactivity (n=5), radioiodine (n=5), stressful events (n=4), heredity (n=1). Ten patients offered unlikely explanations (exposure to chemicals at work n=2, carbimazole or thyroxine n=3, or other unrelated events n=5). All patients who offered explanations linked the onset of GO with events that occurred either shortly before, or at the time of diagnosis of GO. No patient perceived smoking as a relevant factor.

Conclusion: Patient perceptions about their illness are influenced by sequence of events in time and are often irrational. These beliefs may obstruct acceptance of the relevance of real risk factors. Change patients’ perceptions about their illness (and hence changes in lifestyle) requires more than factual information and alternative strategies may be more effective.