Patients with severe Graves' ophthalmopathy have a higher risk of relapsing hyperthyroidism and are unlikely to remain in remission.
OBJECTIVE
To evaluate the relationship between severity of Graves' ophthalmopathy (GO) and relapse/remission rate of associated thyroid disease.


METHODS
One hundred and fifty-eight patients with Graves' disease (GD) were seen within the first 6-12 months after the onset of GO and were followed for at least 18 months. During treatment, GO was classified as mild (n = 65) or severe course (n = 93) by severity and activity scores. All patients received standard anti-thyroid drug (ATD) treatment for 1 year, and in cases of relapse another cycle of ATD, thyroidectomy or radioiodine therapy.


RESULTS
Following ATD treatment, 27 patients (42%) with a mild course of GO went into thyroid disease remission, while only seven (8%) patients with a severe course of GO achieved remission (P < 0.0001). Eventually, 32 patients (49%) with a mild course needed definitive thyroid therapy and the remaining 9% preferred another cycle of ATD. However, among patients with a severe GO course, 84% needed definitive therapy (P < 0.0001) and 8% opted for another course of ATD treatment. The probability of relapse could also be predicted by TBII levels 12 months after initiation of ATD therapy, as 96.8% of patients with TBII levels above 7.5 IU/l relapsed (odds ratio 24.3).


CONCLUSIONS
Patients with severe GO and high TBII are unlikely to go into remission. This allows early decision-making regarding definitive treatment of the thyroid in GD patients with severe GO or very high TBII levels.
Eckstein
Anja K
AK
Department of Ophthalmology, University of Essen, Essen, Germany. anja.eckstein@uni-essen.de
Lax
Hildegard
H
Lösch
Christian
C
Glowacka
Diana
D
Plicht
Marco
M
Mann
Klaus
K
Esser
Joachim
J
Morgenthaler
Nils G
NG
D000328:Adult; D013956:Antithyroid Agents / Q000627:therapeutic use*; D001323:Autoantibodies / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D049970:Graves Ophthalmopathy / Q000097:blood / Q000188:drug therapy*; D006801:Humans; D006980:Hyperthyroidism / Q000097:blood / Q000188:drug therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011989:Receptors, Thyrotropin / Q000276:immunology; D012008:Recurrence; D012074:Remission Induction; D012907:Smoking
D013956:Antithyroid Agents; D001323:Autoantibodies; D011989:Receptors, Thyrotropin