title: Natural history of graves' orbitopathy after treatment.
abstract: Intravenous glucocorticoids are used for Graves' orbitopathy, alone or associated with/followed by additional treatments (orbital radiotherapy, orbital decompression, palpebral or eye surgery). However, the relation between associated/additional treatments and other variables with Graves' orbitopathy outcome following intravenous glucocorticoids is not clear. Thus, the present study was conducted to investigate retrospectively the impact of associated/additional treatments and other variables on Graves' orbitopathy outcome after intravenous glucocorticoids. We evaluated 226 untreated Graves' orbitopathy patients. Following first observation, patients were given intravenous glucocorticoids and re-examined after a median of 46.5 months. The end-points were the relation between Graves' orbitopathy outcome, outcome of NOSPECS score and of the single Graves' orbitopathy features with several variables, including associated/additional treatments. All Graves' orbitopathy features improved significantly after treatment. Overall, Graves' orbitopathy improved in ~60 % of patients (responders), whereas it was stable or worsened in ~40 % of patients (non-responders). Time between first and last observation and clinical activity score at first observation correlated significantly with Graves' orbitopathy outcome. The outcomes of NOSPECS, eyelid aperture, clinical activity score and diplopia correlated with time between the first and last observation. The NOSPECS outcome correlated with gender. The outcomes of proptosis, eyelid aperture and visual acuity correlated with orbital decompression. The outcome of diplopia correlated with orbital radiotherapy. Taking into account the limitations of retrospective investigations, our findings confirm that time (i.e. the natural history of Graves' orbitopathy) is a key factor in determining the long-term outcome of Graves' orbitopathy, radiotherapy is effective for diplopia, and orbital decompression is followed by an amelioration of several Graves' orbitopathy features.
authors.affiliation: Department of Clinical and Experimental Medicine, Endocrinology Units, University of Pisa and University Hospital of Pisa, Pisa, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Menconi
authors.affiliation: 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.affiliation: Department of Clinical and Experimental Medicine, Endocrinology Units, University of Pisa and University Hospital of Pisa, Pisa, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Sabini
authors.affiliation: Department of Surgical, Medical and Molecular Pathology, Ophthalmopathy Unit I, University of Pisa and University Hospital of Pisa, Pisa, Italy.
authors.forename: Teresa
authors.initials: T
authors.lastname: Mautone
authors.affiliation: Department of Surgical, Medical and Molecular Pathology, Ophthalmopathy Unit I, University of Pisa and University Hospital of Pisa, Pisa, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Nardi
authors.affiliation: Radiotherapy Unit, University Hospital of Pisa, Pisa, Italy.
authors.forename: Aldo
authors.initials: A
authors.lastname: Sainato
authors.affiliation: Department of Surgical, Medical and Molecular Pathology, ENT Unit I, University of Pisa and University Hospital of Pisa, Pisa, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Sellari-Franceschini
authors.affiliation: Department of Clinical and Experimental Medicine, Endocrinology Units, University of Pisa and University Hospital of Pisa, Pisa, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Vitti
authors.affiliation: Department of Clinical and Experimental Medicine, Endocrinology Units, University of Pisa and University Hospital of Pisa, Pisa, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Marcocci
authors.affiliation: Department of Clinical and Experimental Medicine, Endocrinology Units, University of Pisa and University Hospital of Pisa, Pisa, Italy. michele.marino@med.unipi.it.
authors.forename: Michele
authors.identifier: http://orcid.org/0000-0003-0365-116X
authors.initials: M
authors.lastname: Marinò
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019299:Decompression, Surgical; D004172:Diplopia / Q000209:etiology / Q000532:radiotherapy; D023381:Endpoint Determination; D005094:Exophthalmos / Q000209:etiology / Q000473:pathology; D005143:Eyelids / Q000473:pathology; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D049970:Graves Ophthalmopathy / Q000473:pathology / Q000532:radiotherapy / Q000628:therapy*; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012727:Sex Characteristics; D013961:Thyroid Gland / Q000000981:diagnostic imaging / Q000473:pathology; D013965:Thyroidectomy; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005938:Glucocorticoids; D007457:Iodine Radioisotopes
keywords: Age; Glucocorticoids; Graves’ disease; Graves’ orbitopathy; Natural history; Radiotherapy