Endocrine Abstracts

Introduction: Graves’ ophthalmopathy (GO) is an autoimmune disorder affecting the retro-orbital tissues. It represents the main extra- thyroidal expression of Graves’ disease (GD). Its onset and progression are influenced by several factors that are potentially modifiable. The aim of this study was to identify risk factors for severe GO.

Methods: Patients with GD were enrolled into a retrospective study. We compared possible risk factors and various clinical findings between patients with mild to moderate GO and those with a severe form.

Results: Of 90 participants with GD, 59 patients (65.8%) presented with GO. Their mean age was 35.15±12.25 years and their M/F ratio was 31/28. GO was the circumstance of discovery of GD in 11% of cases. Its clinical manifestations range from mild findings such as tearing (25.6%), conjunctival injection (16.7%), gritty eyes (10%) and photophobia (8, 9%) to more significant findings including exophthalmos (65.6%), eyelids retraction (41.1%), palpebral edema (18.9%), Oculo-palpebral asynergy (17.8%), exposure keratopathy (7.8%), diplopia (6.7%), reduced visual acuity (5.6%) and strabismus (2.2%). GO was mild in 64.4%, moderate in 16.9% and severe in 18.6% of cases. On multiple logistic regression analysis, smoking status (P=0.005) and male gender (P<0.001) were predictive factors associated with the severity of GO. Other factors such as age, initial free T4 level, TSH-receptor antibodies and a history of diabetes were studied but were not predictive of severe GO.

Conclusion: Although various factors may influence the severity of GO, our study showed that smoking and male gender were the major and the more significant risk factors for developing severe GO. Therefore it is important for patients with GD to stop smoking.