Prevalence and Natural History of Graves' Orbitopathy in a Large Series of Patients With Newly Diagnosed Graves' Hyperthyroidism Seen at a Single Center
Abstract
BACKGROUND: The prevalence and natural history of Graves' orbitopathy (GO) are poorly documented. METHODS: A large series of 346 patients with newly diagnosed and recent onset Graves' hyperthyroidism seen at a single (nontertiary referral) center over an 8-year period were enrolled in an observational prospective study and evaluated for GO activity and severity according to the EUGOGO (European Group on Graves' Orbitopathy) criteria. After excluding patients immediately treated for moderate-to-severe GO, patients undergoing total thyroidectomy or radioactive iodine treatment, and patients lost to follow-up, 237 patients were submitted to antithyroid drug (ATD) treatment, with ocular evaluation at 6, 12, and 18 months. RESULTS: Among the whole cohort, at presentation 255 (73.7%) had no ocular involvement, 70 (20.2%) had mild and inactive GO, 20 (5.8%) had moderate-to-severe and active GO, and 1 (0.3%) had sight-threatening GO with dysthyroid optic neuropathy. Of the 237 patients who completed the 18-month follow-up during or after ATD treatment, 194 (81.9%) had no GO at baseline. Progression to moderate-to-severe GO occurred in 5 (2.6%) of these patients. Of the 43 (18.1%) patients with mild and inactive GO at baseline, 1 (2.4%) progressed to moderate-to-severe GO, and 25 (58.1%) experienced complete remission. CONCLUSIONS: Most patients with newly diagnosed Graves' disease have no ocular involvement. Moderate-to-severe and active GO or sight-threatening GO are rare at presentation and rarely develop during ATD treatment. Most patients (>80%) with no GO at baseline do not develop GO after an 18-month follow-up period. Remission of mild GO occurs in the majority of cases.
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Approximately a third of patients with Graves' hyperthyroidism have some signs and/or symptoms of GO, while only 5% have moderate-to-severe disease.
“Approximately a third of patients with Graves' hyperthyroidism have some signs and/or symptoms of GO, while only 5% have moderate-to-severe disease (517,518).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [518]
GO peaks in incidence in the fifth and sixth decade of life, with a higher prevalence of severe cases in the elderly population.
“The disease peaks in incidence in the fifth and sixth decade of life (517,518,521,522) with a higher prevalence of severe cases in the elderly population (517).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [518]
More recent studies do not identify a clear sex-related risk for GO, while some older studies point to a possible slightly increased risk for men.
“More recent studies do not identify a clear sex-related risk for GO (517,518), while some older studies point to a possible slightly increased risk for men (519,520).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [518]
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- Authors
- Tanda, M. L., Piantanida, E., Liparulo, L., Veronesi, G., Lai, A., Sassi, L., Pariani, N., Gallo, D., Azzolini, C., Ferrario, M., & Bartalena, L.
- Affiliations
- Section of Endocrinology (M.L.T., E.P., L.L., A.L., L.S., N.P., D.G., L.B.), 21100 Varese, Italy
- University of Insubria (IT)
- Corresponding author
- Bartalena, L.
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2013-04-01
- Volume
- 98
- Issue
- 4
- Pages
- 1443-1449
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2021794666
- Cited by
- 328
- References
- 43
- Citations by year
- 2026: 14 · 2025: 30 · 2024: 26 · 2023: 25 · 2022: 36 · 2021: 34 · 2020: 25 · 2019: 15 · 2018: 21 · 2017: 19 · 2016: 31 · 2015: 30 · 2014: 17 · 2013: 5
- FWCI
- 20.69
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- IrInSubria (University of Insubria) (submittedVersion)
- Funders
- Università degli Studi dell'Insubria
- Topics
- Health Sciences › Medicine › Pathology and Forensic Medicine › Ophthalmology and Eye Disorders
- Health Sciences › Medicine › Neurology › Myasthenia Gravis and Thymoma
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Ocular Disorders and Treatments
- Keywords
- Graves' ophthalmopathy, Graves' hyperthyroidism, prevalence, natural history (disease), antithyroid drug therapy, disease progression, remission, dysthyroid optic neuropathy, ocular manifestations
- MeSH terms
- Adult, Algorithms, Female, Graves Disease, Humans, Hyperthyroidism, Longitudinal Studies, Male, Middle Aged, Thyroid Function Tests, Cohort Studies, Prevalence, Age of Onset, Disease Progression, Graves Ophthalmopathy
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