title: Prevalence and natural history of Graves' orbitopathy in the XXI century.
abstract: Graves' orbitopathy (GO) is an autoimmune disorder and the main extrathyroidal expression of Graves' disease. There is a spectrum of ocular involvement in Graves' disease, from complete absence of symptoms and signs to sight-threatening conditions. The prevalence of GO varies in different published series of Graves' patients, due to confounding factors (new diagnosis vs long-lasting disease, way of defining and assessing ocular involvement, treatment of hyperthyroidism with potentially GO-modifying treatments, such as radioiodine). Recent studies, however, suggest that most Graves' patients have mild or no GO at presentation, while moderate-to-severe GO is rare, and sight-threatening GO (mostly due to dysthyroid optic neuropathy) is exceptional in non-tertiary referral centers. The natural course of GO is incompletely defined, particularly in patients with moderate- to-severe GO, because these patients require prompt and disease-modifying therapies for orbital disease. In patients with mild GO at presentation, progression to severe forms is rare, while partial or complete remission is frequent. Progression of pre-existing GO or de novo occurrence of GO is more likely in smokers. There seems to be a trend towards a decline in progression of GO, possibly due to a better control of risk factors (cigarette smoking, thyroid dysfunction, etc.) and a closer interaction between endocrinologists and ophthalmologists allowing an improved integrated management of thyroid and orbital disease.
authors.affiliation: University of Insubria, Circolo Hospital, Viale Borri 57, Varese, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Piantanida
authors.forename: M L
authors.initials: ML
authors.lastname: Tanda
authors.forename: A
authors.initials: A
authors.lastname: Lai
authors.forename: L
authors.initials: L
authors.lastname: Sassi
authors.forename: L
authors.initials: L
authors.lastname: Bartalena
mesh_terms: D018450:Disease Progression; D004704:Endocrinology / Q000266:history; D006111:Graves Disease / Q000150:complications / Q000453:epidemiology / Q000266:history; D049970:Graves Ophthalmopathy / Q000453:epidemiology* / Q000209:etiology* / Q000266:history; D049674:History, 21st Century; D006801:Humans; D015994:Incidence; D015995:Prevalence