P Perros1, M P Žarković2, G C Panagiotou3, C Azzolini4, G Ayvaz5, L Baldeschi6, L Bartalena7, A M Boschi6, M Nardi8, T H Brix9, D Covelli10, C Daumerie11, A K Eckstein12, N Fichter13, S Ćirić14, L Hegedüs9, G J Kahaly15, O Konuk16, J J Lareida13, O E Okosieme17, M Leo18, L Mathiopoulou3, L Clarke19, F Menconi18, D S Morris20, J Orgiazzi21, S Pitz22, M Salvi10, I Muller10, M Knežević23, W M Wiersinga24, N Currò25, C M Dayan17, C Marcocci18, M Marinò18, L Möller13, S H Pearce3, F Törüner26, M Bernard27. 1. Department of Endocrinology, Level 6, Leazes Wing, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, Tyne, UK. petros.perros@ncl.ac.uk. 2. Faculty of Medicine, University of Belgrade, Dr Subotića 8, Belgrade, Serbia. 3. Department of Endocrinology, Level 6, Leazes Wing, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, Tyne, UK. 4. Department of Medicine and Surgery, Section of Ophthalmology, School of Medicine, University of Insubria, Via Guicciardini 9, 21100, Varese, Italy. 5. Department of Endocrinology, Yüksek Ihtisas University Ankara Koru Hastanesi, 1450. Sk. No:13, Kızılırmak, 06510, Çankaya, Ankara, Turkey. 6. Department of Ophthalmology, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium. 7. Endocrine Unit, University of Insubria, Ospedale di Circolo, Viale Borri, 57 21100, Varese, Italy. 8. Dipartimento di Patologia Chirurgica Medica, Molecolare e Dell'Area Critica, Università di Pisa, Pisa, Italy. 9. Department of Endocrinology and Metabolism, Odense University Hospital, 5000, Odense, Denmark. 10. Graves' Orbitopathy Center, Endocrinology, Fondazione IRCCS Cà Granda, University of Milan, via Sforza, 35 - I-20122, Milan, Italy. 11. Department of Endocrinology, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium. 12. Department of Ophthalmology, University of Duisburg-Essen, 45122, Essen, Germany. 13. Interdisciplinary Centre for Graves' Orbitopathy, 4600, Olten, Switzerland. 14. Clinic of Endocrinology, Clinical Centre of Serbia, Belgrade, Serbia. 15. Department of Medicine I, Johannes Gutenberg University Medical Center, 55101, Mainz, Germany. 16. Department of Ophthalmology, Faculty of Medicine, Gazi University, Besevler, Ankara, 06500, Turkey. 17. Thyroid Research Group, Cardiff University School of Medicine, Cardiff, UK. 18. Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy. 19. Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne, UK. 20. Cardiff Eye Unit, University Hospital of Wales, Cardiff, UK. 21. Department of Endocrinology, Centre Hospitalier Lyon-Sud, Lyon, France. 22. Orbital Center, Ophthalmic Clinic, Bürger Hospital, Frankfurt, Germany. 23. Medical School, Clinic for Ophthalmology, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia. 24. Department of Endocrinology, Academic Medical Center, Amsterdam, Netherlands. 25. Department of Surgery, Ophthalmology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. 26. Department of Endocrinology, Faculty of Medicine, Gazi University, Besevler, Ankara, 06500, Turkey. 27. Neuro-Ophthalmology Outpatient Clinics, GHE-Hospices Civils de Lyon and Lyon 1 University, Lyon, France.
Abstract
PURPOSE: Patients with Graves' orbitopathy can present with asymmetric disease. The aim of this study was to identify clinical characteristics that distinguish asymmetric from unilateral and symmetric Graves' orbitopathy. METHODS: This was a multi-centre study of new referrals to 13 European Group on Graves' Orbitopathy (EUGOGO) tertiary centres. New patients presenting over a 4 month period with a diagnosis of Graves' orbitopathy were included. Patient demographics were collected and a clinical examination was performed based on a previously published protocol. Patients were categorized as having asymmetric, symmetric, and unilateral Graves' orbitopathy. The distribution of clinical characteristics among the three groups was documented. RESULTS: The asymmetric group (n = 83), was older than the symmetric (n = 157) group [mean age 50.9 years (SD 13.9) vs 45.8 (SD 13.5), p = 0.019], had a lower female to male ratio than the symmetric and unilateral (n = 29) groups (1.6 vs 5.0 vs 8.7, p < 0.001), had more active disease than the symmetric and unilateral groups [mean linical Activity Score 3.0 (SD 1.6) vs 1.7 (SD 1.7), p < 0.001 vs 1.3 (SD 1.4), p < 0.001] and significantly more severe disease than the symmetric and unilateral groups, as measured by the Total Eye Score [mean 8.8 (SD 6.6) vs 5.3 (SD 4.4), p < 0.001, vs 2.7 (SD 2.1), p < 0.001]. CONCLUSION: Older age, lower female to male ratio, more severe, and more active disease cluster around asymmetric Graves' orbitopathy. Asymmetry appears to be a marker of more severe and more active disease than other presentations. This simple clinical parameter present at first presentation to tertiary centres may be valuable to clinicians who manage such patients.
PURPOSE:Patients with Graves' orbitopathy can present with asymmetric disease. The aim of this study was to identify clinical characteristics that distinguish asymmetric from unilateral and symmetric Graves' orbitopathy. METHODS: This was a multi-centre study of new referrals to 13 European Group on Graves' Orbitopathy (EUGOGO) tertiary centres. New patients presenting over a 4 month period with a diagnosis of Graves' orbitopathy were included. Patient demographics were collected and a clinical examination was performed based on a previously published protocol. Patients were categorized as having asymmetric, symmetric, and unilateral Graves' orbitopathy. The distribution of clinical characteristics among the three groups was documented. RESULTS: The asymmetric group (n = 83), was older than the symmetric (n = 157) group [mean age 50.9 years (SD 13.9) vs 45.8 (SD 13.5), p = 0.019], had a lower female to male ratio than the symmetric and unilateral (n = 29) groups (1.6 vs 5.0 vs 8.7, p < 0.001), had more active disease than the symmetric and unilateral groups [mean linical Activity Score 3.0 (SD 1.6) vs 1.7 (SD 1.7), p < 0.001 vs 1.3 (SD 1.4), p < 0.001] and significantly more severe disease than the symmetric and unilateral groups, as measured by the Total Eye Score [mean 8.8 (SD 6.6) vs 5.3 (SD 4.4), p < 0.001, vs 2.7 (SD 2.1), p < 0.001]. CONCLUSION: Older age, lower female to male ratio, more severe, and more active disease cluster around asymmetric Graves' orbitopathy. Asymmetry appears to be a marker of more severe and more active disease than other presentations. This simple clinical parameter present at first presentation to tertiary centres may be valuable to clinicians who manage such patients.