Effect of Abnormal Thyroid Function on the Severity of Graves' Ophthalmopathy
Abstract
Many clinicians have the impression that treatment of thyroid dysfunction ameliorates ophthalmopathy in Graves' disease. The aim of our study was to relate thyroid function to the severity of Graves' ophthalmopathy. We studied 90 patients with Graves' ophthalmopathy and Graves' hyperthyroidism in whom severity of Graves' ophthalmopathy and thyroid function (regardless of antithyroid treatment) were assessed when referred to our institution. Patients were assigned to four groups (A through D) with increasingly severe Graves' ophthalmopathy using Total Eye Score based on the NOSPECS classification. The percentage of dysthyroid patients in each group was determined: group A had 23% dysthyroid patient (5); group B, 32% (9); group C, 61% (14); and group D, 47% (8). More dysthyroid patients were in the groups with severe Graves' ophthalmopathy. We also compared the severity of Graves' ophthalmopathy between euthyroid (n = 54) and dysthyroid (n = 36) patients: euthyroid patients had less proptosis (19.9 +/- 3.5 vs 20.8 +/- 3.4 mm), better visual acuity (0.93 +/- 0.17 vs 0.88 +/- 0.18), and lower Total Eye Score (8.6 +/- 6.6 vs 10.6 +/- 6.6). We conclude that dysthyroidism is associated with more severe Graves' ophthalmopathy. Our findings suggest that meticulous control of thyroid function also during antithyroid treatment is important in the management of Graves' ophthalmopathy.
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An early study noted that patients who were either hypo- or hyperthyroid had more severe GO than euthyroid patients.
“An early study noted that patients who were either hypo-or hyperthyroid had more severe GO than euthyroid patients (535).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [535]
Smoking is the most important known risk factor for the development or worsening of GO, unrelated to type of therapy for GO, and consistent data from several studies show a detrimental effect of smoking on GO in patients treated with RAI.
“Smoking is the most important known risk factor for the development or worsening of GO, unrelated to type of therapy for GO (535), and consistent data from several studies show a detrimental effect of smoking on GO in patients a ATDs or thyroidectomy are also recommended treatment options in each of these scenarios, and they are the preferred choice of therapy in patients with active and moderate-”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [535]
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“An early study noted that patients who were either hypo- or hyperthyroid had more severe GO than euthyroid patients (535).”
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- Authors
- Prummel, M. F.
- Affiliations
- Amsterdam UMC Location University of Amsterdam (NL)
- Corresponding author
- Prummel, Mark F.
- Venue
- Archives of Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 1990-05-01
- Volume
- 150
- Issue
- 5
- Pages
- 1098
- ISSN
- 0003-9926 (ISSN-L)
- OpenAlex
- W2018732743
- Cited by
- 238
- References
- 34
- Citations by year
- 2026: 6 · 2025: 8 · 2024: 7 · 2023: 9 · 2022: 9 · 2021: 7 · 2020: 11 · 2019: 7 · 2018: 5 · 2017: 4 · 2016: 12 · 2015: 10 · 2014: 8 · 2013: 9 · 2012: 8
- FWCI
- 4.17
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Topics
- Health Sciences › Medicine › Pathology and Forensic Medicine › Ophthalmology and Eye Disorders
- Health Sciences › Medicine › Neurology › Myasthenia Gravis and Thymoma
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Keywords
- Graves' ophthalmopathy, Graves' disease, thyroid dysfunction, hypothyroidism, hyperthyroidism, proptosis, visual acuity, antithyroid drug therapy
- MeSH terms
- Adult, Aged, Female, Graves Disease, Humans, Male, Middle Aged, Antithyroid Agents, Thyroid Function Tests, Thyroid Gland
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