title: Prevalence, Phenotype, and Psychosocial Well-Being in Euthyroid/Hypothyroid Thyroid-Associated Orbitopathy.
abstract: BACKGROUND
  At the onset of thyroid-associated orbitopathy (TAO), most patients are hyperthyroid, while scarce data are available on euthyroid/hypothyroid TAO. The aim of this study was to assess the prevalence, phenotype, and psychosocial burden of patients with initially euthyroid/hypothyroid TAO.
  
  
  METHODS
  The medical records of 461 consecutive and unselected patients with TAO followed at a specialized joint thyroid-eye clinic were analyzed within this retrospective cross-sectional study. Main outcome measures were the prevalence of initially eu- or hypothyroid TAO as well as ophthalmic signs and symptoms, disease-specific quality of life (QoL), work impairment, and rate of psychotherapy in initially eu-/hypothyroid versus hyperthyroid TAO.
  
  
  RESULTS
  The prevalences of eu-/hypothyroid and hyperthyroid TAO were 4.3% (n=20; [confidence interval, CI, 2.6-6.3]) and 95.7% (n=441; [9.37-9.74]), respectively. In 12 patients (2.6% [CI 1.3-4.3]), Hashimoto's thyroiditis was present and in 8 (1.7% [CI 0.7-3.0]) no thyroid disease was noted at the time of inclusion. One (0.05%) patient with eu-/hypothyroid TAO and 172 (39%) with hyperthyroid TAO had clinically active TAO (p=0.001). In eu-/hypothyroid versus hyperthyroid patients, 14 (70%) versus 135 (30.6%) had a mild TAO, 6 (30%) versus 183 (64.2%) a moderate-to-severe TAO, and 0 versus 23 (5.4%) had a sight-threatening TAO (p<0.001). TAO was asymmetric in 4 (20%) eu-/hypothyroid and in 27 (6.1%) hyperthyroid patients (p=0.038). Only 5.3% versus 30.2% and 10.5% versus 44.1% of patients with eu-/hypothyroid and hyperthyroid TAO, respectively, were on sick leave (p=0.003) or work disabled (p=0.018). QoL was less impaired in eu-/hypothyroid versus hyperthyroid TAO (median visual functioning and appearance scores: 100 versus 75; p<0.001 and 81.25 versus 75; p=0.315). Of patients with eu-/hypothyroid and hyperthyroid TAO, 15% and 20.2% had psychotherapy respectively (p=0.409). Eu-/hypothyroid TAO was positively (odds ratio 7.05, p=0.060) and negatively (odds ratio: 0.09, p=0.026) associated with a unilateral involvement and thyrotropin-receptor autoantibodies respectively.
  
  
  CONCLUSIONS
  Compared with hyperthyroid TAO, QoL and working ability are less impaired in eu-/hypothyroid TAO with an often asymmetric and less severe clinical phenotype.
authors.affiliation: 1 Department of Ophthalmology, Johannes Gutenberg University Medical Center , Mainz, Germany .|2 Center for Thrombosis and Hemostasis, Johannes Gutenberg University Medical Center , Mainz, Germany .
authors.forename: Katharina A
authors.initials: KA
authors.lastname: Ponto
authors.affiliation: 3 Department of Biomedical Statistics, Johannes Gutenberg University Medical Center , Mainz, Germany .
authors.forename: Harald
authors.initials: H
authors.lastname: Binder
authors.affiliation: 4 Department of Medicine I, Johannes Gutenberg University Medical Center , Mainz, Germany .
authors.forename: Tanja
authors.initials: T
authors.lastname: Diana
authors.affiliation: 4 Department of Medicine I, Johannes Gutenberg University Medical Center , Mainz, Germany .
authors.forename: Nina
authors.initials: N
authors.lastname: Matheis
authors.affiliation: 1 Department of Ophthalmology, Johannes Gutenberg University Medical Center , Mainz, Germany .
authors.forename: Anna F
authors.initials: AF
authors.lastname: Otto
authors.affiliation: 1 Department of Ophthalmology, Johannes Gutenberg University Medical Center , Mainz, Germany .
authors.forename: Susanne
authors.initials: S
authors.lastname: Pitz
authors.affiliation: 1 Department of Ophthalmology, Johannes Gutenberg University Medical Center , Mainz, Germany .
authors.forename: Norbert
authors.initials: N
authors.lastname: Pfeiffer
authors.affiliation: 4 Department of Medicine I, Johannes Gutenberg University Medical Center , Mainz, Germany .
authors.forename: George J
authors.initials: GJ
authors.lastname: Kahaly
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D049970:Graves Ophthalmopathy / Q000150:complications / Q000453:epidemiology / Q000523:psychology*; D006801:Humans; D007037:Hypothyroidism / Q000453:epidemiology / Q000523:psychology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009916:Orbital Diseases / Q000453:epidemiology* / Q000523:psychology*; D010641:Phenotype; D015995:Prevalence; D011613:Psychotherapy; D011788:Quality of Life; D012044:Regression Analysis; D012189:Retrospective Studies; D013959:Thyroid Diseases / Q000453:epidemiology / Q000523:psychology; D013961:Thyroid Gland / Q000276:immunology; D016896:Treatment Outcome; D055815:Young Adult