A Study of Factors Related to the Course of Graves' Ophthalmopathy

Joong-Hun Kim; Tae Soo Lee

doi:10.3341/jkos.2011.52.3.255

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Kim and Lee: A Study of Factors Related to the Course of Graves' Ophthalmopathy

Original Article

J Korean Ophthalmol Soc 2011;52(3):255-260.

Published online: 7 September 2011

DOI: https://doi.org/10.3341/jkos.2011.52.3.255

A Study of Factors Related to the Course of Graves' Ophthalmopathy

Joong-Hun Kim, MD, Tae Soo Lee, MD, PhD

Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea

Address reprint requests to Tae Soo Lee, MD, PhD Department of Ophthalmology, Korea Medical Center Guro Hospital #97 Gurodong-gil, Guro-gu, Seoul 152-703, Korea Tel: 82-2-2626-1260, Fax: 82-2-857-8580, E-mail: tsoooo@hanmail.net

Received 1 June 201024 August 2010 Accepted 13 December 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate the risk factors related to the course of Graves’ ophthalmopathy (GO).

Methods

This is a retrospective study of 125 patients who were referred to our clinic and diagnosed with GO from March 2006 to August 2008. Ophthalmic examinations and a thyroid function test including TSI were performed at the time of diagnosis and every 3 months after diagnosis. All patients were classified as having a mild or severe course of GO, according to Clinical Activity Score (CAS) and NOSPECS classifications.

Results

This statistical analysis of each group revealed that female sex (p = 0.04), age (p = 0.0004), smoking (p = 0.003), and high TSI level (p = 0.009) were significant factors for severe course of GO at the time of diagnosis. TSI levels at each of the 3 visits during the followup were significantly higher in patients with a severe course of GO, as compared to patients with a mild course of GO (first visit: p = 0.003, second visit: p = 0.002, third visit: p = 0.006).

Conclusions

Female sex, age, smoking, and high TSI level appear to be the risk factors that can predict the severity of GO at the time of diagnosis. Additionally, the TSI level can reflect the severity of GO during the followup periods.

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Keywords: Graves' ophthalmopathy, Risk factor, Severity

References

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Figure 1.

Association between TSI^∗ level and the severity. ^∗ TSI = TSH stimulating immunoglobin.

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Table 1.

Characteristics of patients with Graves’ ophthalmopathy (n^∗ = 125)

Patient characteristics	N^∗/mean ± SD^†	(%)
Study population	125	100
Mean age ± SD	49.6 ± 9.8
Sex (male/female)	52/73	41.6/58.4
Smoker	48	38.4
Treatment for ophthalmopathy
No treatment	10	8.0
Conservative treatment	59	47.2
High-dose IV^‡ pulse steroid therapy	45	36.0
Oral steroid therapy	38	30.4
Orbital decompression	4	3.2
Severity of GO^§
Mild group	85	68
Severe group	40	32
Thyroid function
Hyperthyroid	28	22.4
Euthyroid	49	39.2
Hypothyroid	11	8.8
Others	37	29.6
Treatments for thyroid dysfunction
Antithyroid medication	60	48
Thyroidectomy	17	13.6
Radioiodine treatment	11	8.8
Thyroid hormone	33	26.4

^∗ n = number of patients;

^† SD = standard deviation;

^‡ IV = intravenous;

^§ GO = Graves’ ophthalmopathy.

Table 2.

Distribution of Clinical Activity Score (CAS) and NOSPECS classification among the Graves’ ophthalmopathy patients

CAS^∗	n^† (%)	NOSPECS^‡	n (%)
0	5 (4.0)	0	1 (0.8)
1	37 (29.6)	1	4 (3.2)
2	32 (25.6)	2	15 (12.0)
3	27 (21.6)	3	47 (37.6)
4	23 (18.4)	4	20 (16.0)
5	8 (6.4)	5	31 (24.8)
6	5 (4.0)	6	2 (1.6)
7	2 (1.6)	>6	5 (4.0)
Total	125 (100)	Total	125 (100.0)

^∗ CAS = clinical activity score;

^† n = number of patients;

^‡ NOSPECS = no physical sign, only signs, soft tissue involvement, proptosis, extraocular muscle involvement, corneal involvement, sight loss.

Table 3.

Risk factors with influence on the severity of Graves’ ophthalmopathy

Risk factor	p-value^∗	Risk ratio (95% CI)
TSI^† level	0.0090	1.36^‡
Smoking	0.0030	8.12
Sex (female)	0.0400	4.62
Age	0.0004	1.12
Radioiodine treatment	0.2300	1.72
Thyroidectomy treatment	0.5600	1.65
Free T4 level (ng/dL)	0.8000	1.11
TSH^§ level (uIU/mL)	0.7000	1.05

^∗ Multiple logistic regression analysis p < 0.05: statistically significant;

^† TSI = TSH stimulating immunoglobin;

^‡ The risk of 1.36 for TSI means that with a TSI increase of 1 IU/liter, the risk of a active course is 1.36 times (36%) higher;

^§ TSH = thyroid stimulating hormone.

Table 4.

TSI^∗ values (median) in mild and severe Graves’ ophthalmopathy

Time point: Months after GO^† diagnosis	Group 1 (Mild group)	Group 2 (Severe group)	p-value^‡
3 months	6.8 (IU/L)	21.6 (IU/L)	0.003
6 months	4.3 (IU/L)	16.0 (IU/L)	0.002
12 months	2.2 (IU/L)	9.9 (IU/L)	0.006

TSI = TSH stimulating immunoglobin;

^† GO = Graves’ ophthalmopathy;

^‡ Mann-Whitney U test p<0.05: statistically significant.

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