Endocrine Abstracts

Introduction

Graves’ disease (GD) is an autoimmune thyroiditis frequently associated with development of Graves’ orbitopathy (GO). Diplopia (double vision) is a major determinant of work disability in patients with GO. The aim of our study was to assess the prevalence of diplopia and strabismus in patients with GO.

Methods

This is a single-center observational study in an outpatient clinic of autoimmune endocrinopathies at a Tertiary, General, University Hospital. Patients with GO and increased levels of thyroid-stimulating immunoglobulin (TSI b 1.75 IU/l) were included in the study. Clinical activity score (CAS), diplopia and strabismus were evaluated by a single ophthalmologist according to the European Consensus Report. Laboratory tests for TSH, T3, FT4, TSI, TgAbs, TPOAbs, complete blood count, liver enzymes and thyroid sonography were performed in all patients.

Results

A total of 36 patients (72.2% females) with a mean age of 54 ± 11.8 years were analyzed. The median TSI levels were 9.1 IU/l (IQR 22.3), and the mean CAS score was 3.24 ± 1.4. 19.4% (7/36) of the patients had undergone total thyroidectomy, 11.1% (4/36) had thyroid cancer, 47.2% (17/36) had other autoimmunities, and 65.6% (21/32) had smoking history. Diplopia was present in 38.9% (14/36) and strabismus in 5.6% (2/36) of the patients. Diplopia was not significantly associated with gender, TSI levels, thyroidectomy, thyroid cancer, and the presence of other autoimmunities (P = NS), but patients with diplopia were older than those without (60.8 ± 11.3 vs 49.7 ± 10.1, P = 0.004).

Conclusion

The prevalence of diplopia was 38.9% in the studied group of patients with GO, whereas strabismus was much less frequent (5.6%). Diplopia was associated with older age in patients with GO.