title: Absence of seasonal variation in Graves disease.
abstract: OBJECTIVE
  To determine whether there is an identifiable pattern of seasonal variation in the onset of symptoms of orbitopathy and thyrotoxicosis in patients with Graves disease.
  
  
  METHODS
  This retrospective, noncomparative case series reviewed 305 randomly selected office records of patients referred to one author (M.K.) for evaluation of Graves orbitopathy between July 1990 and June 1998. All patients met inclusion criteria for the diagnosis of Graves orbitopathy. During initial evaluation for orbitopathy, patients identified the date of onset of orbital symptoms as well as the earliest date of either onset of thyroid symptoms or documented thyroid abnormality. Patients were excluded from analysis of seasonal variation if they could not recall the month of symptom onset or were euthyroid. The onset of orbital symptoms and identification of dysthyroid state were analyzed by calendar month and season. The chronological relationship of the development of orbital and thyroid symptoms was evaluated.
  
  
  RESULTS
  No significant seasonal variation appeared in the onset of orbital symptoms or identification of dysthyroidism. Out of 148 patients, 115 (78%) developed symptoms of orbital disease within 18 months of the identification of dysthyroidism. The most common presenting orbital symptoms were swelling of the lid or prominence of the globe.
  
  
  CONCLUSIONS
  This study fails to provide evidence for a seasonal influence on the incidence of Graves disease and the associated orbitopathy.
authors.affiliation: College of Physicians and Surgeons, Columbia University, New York, New York, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Facciani
authors.forename: M
authors.initials: M
authors.lastname: Kazim
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D018450:Disease Progression; D005260:Female; D006111:Graves Disease / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012621:Seasons; D014481:United States / Q000453:epidemiology