Endocrine Abstracts

Introduction: Knowing mental representations about the phenomenon of illness and medical care allows the clinical team to have better emotional handling of their patients, with gains in greater adherence to treatments. Graves’ Ophthalmopathy is an inflammatory disease with primary involvement of the extraocular muscles and orbit, being the most frequent extrathyroidal manifestation of Graves’ disease (GD). Many patients have psychological status changes even after successful treatment of hyperthyroidism, especially when the disfiguring signs of ophthalmopathy are predominant. An understanding of the symbolic aspects linked to this condition help endocrinologists to have a relationship more harmonious with them.

Aims: To interpret emotional meanings in reports of euthyroid GD patients with ophthalmopathy under follow-up, discussing contradictions perceived between a stigmatized body and clinical laboratory euthyroidism.

Method: Clinical-Qualitative design of Turato. Data was collected using semi-directed interviews with open-ended questions in-depth, carried out with patients at a tertiary outpatient service specialized in thyroid dysfunctions. The interview material was audio-recorded and fully transcribed. The interviews were treated by Clinical-Qualitative Content Analysis described by Seven Steps of Faria-Schützer. It is based on psychodynamic concepts from the Medical Psychology theoretical framework, whose main author is Michael Balint. The sample was closed by the Theoretical Saturation of Information studied by Fontanella et al. The finding validation has occurred by peers at the Laboratory of Clinical-Qualitative Research.

Results: The sample was composed by 10 patients. From the search of nuclei of meanings in the reports, four categories of analysis were constructed: 1) “No, this is not normal, I must have cancer”: psychodynamics of the physician-patient relationship in Graves’ Disease; 2) Types of illness according to their manifestations and auto-perception: silent illness and non-silent ones; 3) “The eyes are everything”: the impacts of the disfiguring alterations of ophthalmopathy; 4) The contradiction perception between clinical and laboratory normality the stigmas of ophthalmopathy.

Conclusions: The patients with ophthalmopathy, maintained emotional distress despite being euthyroid, manifested by various emotional meanings reported in the interviews. The clinical-laboratory diagnosis of Graves’ Disease alone was not sufficiently capable of responding to the psychological demands of the patients. Proper listening to emotional symbolic meanings attributed by patients could help endocrinologists in handling this setting.