title: Management of Graves' orbitopathy in Latin America: an international questionnaire study compared with Europe.
abstract: BACKGROUND
  Management of Graves' orbitopathy (GO) and dysthyroid optic neuropathy (DON) continues to be challenging. Other surveys have been successful in elucidating trends in GO management. Knowledge of current practice by members of the Latin American Thyroid Society (LATS) who manage patients with GO was targeted by distribution of a questionnaire. We compared our results with a previously reported European Thyroid Association (ETA) survey.
  
  
  OBJECTIVE
  To determine how endocrinologists in Latin America access and treat patients with GO and compare the results with the same European survey.
  
  
  RESULTS
  One hundred and two responders representing endocrinologists from 10 countries participated in the survey. Most (57%) participate in a multidisciplinary setting for GO management. Access to a surgeon for orbital decompression was available only 'within months' according to 48.3% of responders. Despite suspected DON, 32.4% were reluctant to recommend urgent referral to an eyecare physician. Steroids were preferred as the first-option therapy by 88.2% of responders (by intravenous route by 57.8% of these). The presence of diabetes reduced the use of steroids to 64.7% (P < 0.001) and increased the use of other immunosuppressive agents (from 1% to 9.8%, P < 0.01). Development of cushingoid features resulted in a reduction in steroid use to 40.2% (P < 0.001), with increased preference for irradiation (from 23.5% to 52.9%, P < 0.001) and nonsteroidal immunosuppressive drugs (from 1% to 10.8%, P < 0.01), along with a nonsignificant trend to higher indication of orbital surgery (from 24.5% to 34.3%).
  
  
  CONCLUSIONS
  Some potential deficiencies in the diagnosis and management of DON and hyperthyroidism were observed in our survey, highlighting the need for improvement in specialist education and the quality of care offered to patients with GO in Latin America.
authors.affiliation: Division of Endocrinology and Metabolism, Department of Medicine, Federal University of Paraná, Curitiba, Brazil. ramoshelton@hotmail.com
authors.forename: Helton E
authors.initials: HE
authors.lastname: Ramos
authors.forename: Leandro A
authors.initials: LA
authors.lastname: Diehl
authors.forename: Cleber P
authors.initials: CP
authors.lastname: Camacho
authors.forename: Petros
authors.initials: P
authors.lastname: Perros
authors.forename: Hans
authors.initials: H
authors.lastname: Graf
mesh_terms: D000328:Adult; D000368:Aged; D013956:Antithyroid Agents / Q000627:therapeutic use; D048909:Diabetes Complications / Q000628:therapy; D005060:Europe; D005938:Glucocorticoids / Q000627:therapeutic use; D049970:Graves Ophthalmopathy / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D006801:Humans; D006980:Hyperthyroidism / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D007843:Latin America; D012955:Societies, Medical; D011795:Surveys and Questionnaires
chemical_list: D013956:Antithyroid Agents; D005938:Glucocorticoids; D007457:Iodine Radioisotopes