title: Role of the underlying thyroid disease on the phenotype of Graves' orbitopathy in a tertiary referral center.
abstract: BACKGROUND
  Clinically overt Graves' orbitopathy (GO) is associated with Graves' disease (GD) in approximately 95% of cases, whereas the remaining 5% is observed in patients with hypothyroid autoimmune thyroiditis (AT) or without overt thyroid dysfunction (euthyroid GO). However, it is not known whether there is a difference in terms of GO phenotype between patients with GD and those with hypothyroid AT or without thyroid dysfunction, and hence this is investigated here.
  
  
  METHODS
  The study design was to evaluate retrospectively all consecutive patients with a recent manifestation of GO, seen at their first visit to a tertiary referral center over a period of 10 years. In total, 358 GO patients were studied, and all of them underwent GO assessment.
  
  
  RESULTS
  Of the 358 patients studied, 341 had hyperthyroid GD, 10 had AT with hypothyroidism, and seven had euthyroid GO. Age, sex, and smoking habits were similar in the three groups, as was the time since GO was first noticed (GO duration). The vast majority of patients had moderate to severe, active GO, as expected in a tertiary referral center. Exophthalmometry, eyelid width, clinical activity score (CAS), diplopia, and visual acuity did not differ between patients with GD and those with AT or euthyroid GO, suggesting that the GO phenotype was similar. Accordingly, the NOSPECS score did not differ between the three groups.
  
  
  CONCLUSIONS
  The phenotype of GO is similar regardless of the underlying thyroid disease. Because this study was performed in a tertiary referral center, this conclusion can be restricted only to patients who develop moderate to severe GO.
authors.affiliation: 1 Department of Clinical and Experimental Medicine, Endocrinology Units, University of Pisa and University Hospital of Pisa , Pisa, Italy .
authors.forename: Marenza
authors.initials: M
authors.lastname: Leo
authors.forename: Francesca
authors.initials: F
authors.lastname: Menconi
authors.forename: Roberto
authors.initials: R
authors.lastname: Rocchi
authors.forename: Francesco
authors.initials: F
authors.lastname: Latrofa
authors.forename: Eleonora
authors.initials: E
authors.lastname: Sisti
authors.forename: Maria Antonietta
authors.initials: MA
authors.lastname: Profilo
authors.forename: Barbara
authors.initials: B
authors.lastname: Mazzi
authors.forename: Eleonora
authors.initials: E
authors.lastname: Albano
authors.forename: Marco
authors.initials: M
authors.lastname: Nardi
authors.forename: Paolo
authors.initials: P
authors.lastname: Vitti
authors.forename: Claudio
authors.initials: C
authors.lastname: Marcocci
authors.forename: Michele
authors.initials: M
authors.lastname: Marinò
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D006111:Graves Disease / Q000150:complications* / Q000473:pathology*; D049970:Graves Ophthalmopathy / Q000209:etiology* / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009915:Orbit / Q000473:pathology; D010641:Phenotype; D011989:Receptors, Thyrotropin / Q000235:genetics; D012107:Research Design; D012189:Retrospective Studies; D012907:Smoking; D062606:Tertiary Care Centers; D013967:Thyroiditis, Autoimmune / Q000473:pathology; D055815:Young Adult
chemical_list: D011989:Receptors, Thyrotropin