Endocrine Abstracts

Background: Early diagnosis and surveillance of Graves’ Orbitopathy (GO) is essential to prevent severe, sight-threatening complications and long-term disability; therefore, it is highly desirable to identify risk factors and early predictors of severe disease. GO is clinically assessed using the Clinical Activity Score (CAS) and the EUGOGO Severity Scale (ESS), which are subjective, qualitative tests that are used to evaluate the activity and severity at the anterior orbit. However, we propose the use of radiological characteristics, such as specific muscle enlargement, to predict the progression to severe disease. Therefore, we evaluated the clinical and radiological features of GO in patients presenting to multi-centre multidisciplinary teams in London and identified factors predictive of severe disease.

Method: A retrospective patient-cohort study of 356 patients referred to three multidisciplinary (MDT) clinics in London between 2012 and 2021 was investigated. Patient characteristics were statistically analysed to investigate group-wise differences and correlations to help predict subsequent disease activity. From this analysis, odds ratios were produced for both clinical and radiological parameters.

Results: Median age was 46.0 years (interquartile range: 36-55), 79.2% female, 41.2% Asian. Out of 356 patients, 43.0% had moderate-severe or sight-threatening disease. On odds ratio analysis, clinical parameters of older age (OR 1.96 (1.07-3.59)), male gender (OR 2.03 (1.19-3.45)), hyperthyroidism (OR 3.64 (2.08-6.38)) were associated with more severe disease. On analysis of radiological parameters, superior rectus-levator complex muscle involvement was also associated with more severe disease (OR 1.90 (1.03-3.50)).

Conclusion: These results suggest that cases of higher severity disease were more prevalent in the older demographic and the male population. The presence of radiological superior rectus-levator muscle involvement was associated with a higher incidence of moderate-to-severe disease. This provides an additional significant radiological criterion for diagnosing moderate-to-severe disease and providing all-important early intervention for these patients. This highlights the merit of both clinical and radiological assessment for the diagnosis and surveillance of Graves’ Ophthalmology.