Abstract

SA.25.02

Risk factors in Graves ophthalmopathy (GO)

Eckstein A.¹, Esser J.¹, Mann K.^2
1Department of Ophthalmology University of Essen, ²Department of Medicine, Division of Endocrinology and, University of Essen

Graves hyperthyroidism (GD) and ophthalmopathy (GO) share several risk factors for severe course of both diseases. The disease is more frequent in women than in men (1:5), but men tend to develop a more severe course. Cigarette smoking is associated with a higher prevalence of GO among GD patients, a higher degree of disease severity and a lower effectiveness of medical treatment. Concerning hyperthyroidism cigarette smoking is associated with a higher relapse rate. High TSH-receptor antibody (TRAb) levels are associated with a more severe course of GO and a lower remission rate of GD. Patients with GD/GO report a 2-5 fold increase of stressful life events before disease onset and patients with severe GO present a significant psychosocial morbidity. About 30-40% of the patients have relatives with thyroid autoimmune diseases. The management of hyperthyroidism plays an important role for the course of GO. Reaching euthyroidism lead to significant improvement of GO. Once euthyroid with antithyroid drug therapy and thyroidectomy (remnant <4g) no change or further improvement can be observed while radioiodine can cause a progression of GO in approximately 15-33%, which can be eliminated by concomitant middle dose glucocorticoid treatment and in mild/inactive cases even with early L-Thyroxine administration.

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