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Natural course of mild Graves’ orbitopathy: is it a chronic remitting or a transient disease?

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Abstract

Background/Aims

The natural course of Graves’ orbitopathy (GO) has been poorly documented. The aim of this review is to provide current knowledge regarding the natural course of mild GO, trying to address the issue of whether and to what extent it constitutes a chronic remitting or transient disease.

Methods

We systematically searched PubMed for English language publications until August 2016 under the following terms: “Graves’ orbitopathy” OR “Graves’ ophthalmopathy” OR “thyroid eye disease” AND “natural course” OR “natural history”.

Results

Few studies have investigated the course of mild orbital disease in patients with GO. Large controlled trials are lacking and data can be extracted mainly from small retrospective and some prospective studies, after excluding patients who had received radioiodine for thyrotoxicosis or surgical treatment for GO. In general, more than half of GO patients may show spontaneous improvement in their clinical features, whereas no safe conclusions can be drawn with regard to complete resolution, with percentages ranging from 6 to 58 %.

Conclusions

The question whether mild GO is a remitting, albeit chronic disease, or even a transient event in the course of Graves’ disease, remains currently unanswered.

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References

  1. Bartalena L, Fatourechi V (2014) Extrathyroidal manifestations of Graves’ disease: a 2014 update. J Endocrinol Invest 37:691–700

    Article  CAS  PubMed  Google Scholar 

  2. Anagnostis P, Adamidou F, Poulasouchidou M, Karras S (2013) Severe eyelid oedema in Graves’ ophthalmopathy. BMJ Case Rep 2013. doi:10.1136/bcr-2013-010305

  3. Terwee C, Wakelkamp I, Tan S, Dekker F, Prummel MF, Wiersinga W (2002) Long-term effects of Graves’ ophthalmopathy on health-related quality of life. Eur J Endocrinol 146:751–757

    Article  CAS  PubMed  Google Scholar 

  4. Bartley GB, Fatourechi V, Kadrmas EF, Jacobsen SJ, Ilstrup DM, Garrity JA, Gorman CA (1996) Long-term follow-up of Graves ophthalmopathy in an incidence cohort. Ophthalmology 103:958–962

    Article  CAS  PubMed  Google Scholar 

  5. Bartalena L, Baldeschi L, Boboridis K, Eckstein A, Kahaly GJ, Marcocci C, Perros P, Salvi M, Wiersinga WM, European Group on Graves’ Orbitopathy (EUGOGO) (2016) The 2016 European Thyroid Association/European Group on Graves’ Orbitopathy Guidelines for the Management of Graves’ Orbitopathy. Eur Thyroid J 5:9–26

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Rundle FF (1957) Management of exophthalmos and related ocular changes in Graves’ disease. Metabolism 6:36–47

    CAS  PubMed  Google Scholar 

  7. Marcocci C, Bruno-Bossio G, Manetti L, Tanda ML, Miccoli P, Iacconi P, Bartolomei MP, Nardi M, Pinchera A, Bartalena L (1999) The course of Graves’ ophthalmopathy is not influenced by near total thyroidectomy: a case-control study. Clin Endocrinol (Oxf) 51:503–508

    Article  CAS  Google Scholar 

  8. Tallstedt L, Lundell G, Tørring O, Wallin G, Ljunggren JG, Blomgren H, Taube A, The Thyroid Study Group (1992) Occurrence of ophthalmopathy after treatment for Graves’ hyperthyroidism. N Engl J Med 326:1733–1738

    Article  CAS  PubMed  Google Scholar 

  9. Bartalena L, Macchia PE, Marcocci C, Salvi M, Vermiglio F (2015) Effects of treatment modalities for Graves’ hyperthyroidism on Graves’ orbitopathy: a 2015 Italian Society of Endocrinology Consensus Statement. J Endocrinol Invest 38:481–487

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Selva D, Chen C, King G (2004) Late reactivation of thyroid orbitopathy. Clin Exp Ophthalmol 32:46–50

    Article  PubMed  Google Scholar 

  11. Werner SC (1969) Classification of the eye changes of Graves’ disease. J Clin Endocrinol Metab 29:982–984

    Article  CAS  PubMed  Google Scholar 

  12. Agapitos PJ, Hart IR (1987) Long-term follow-up of ophthalmic Graves’ disease. CMAJ 136:369–372

    CAS  PubMed  PubMed Central  Google Scholar 

  13. Teng CS, Yeo PP (1977) Ophthalmic Graves’s disease: natural history and detailed thyroid function studies. Br Med J 1:273–275

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Noth D, Gebauer M, Müller B, Bürgi U, Diem P (2001) Graves’ ophthalmopathy: natural history and treatment outcomes. Swiss Med Wkly 131:603–609

    CAS  PubMed  Google Scholar 

  15. Menconi F, Profilo MA, Leo M, Sisti E, Altea MA, Rocchi R, Latrofa F, Nardi M, Vitti P, Marcocci C, Marinò M (2014) Spontaneous improvement of untreated mild Graves’ ophthalmopathy: Rundle’s curve revisited. Thyroid 24:60–66

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Streeten DH, Anderson GH Jr, Reed GF, Woo P (1987) Prevalence, natural history and surgical treatment of exophthalmos. Clin Endocrinol (Oxf) 27:125–133

    Article  CAS  Google Scholar 

  17. Perros P, Crombie AL, Kendall-Taylor P (1995) Natural history of thyroid associated ophthalmopathy. Clin Endocrinol (Oxf) 42:45–50

    Article  CAS  Google Scholar 

  18. Tanda ML, Piantanida E, Liparulo L, Veronesi G, Lai A, Sassi L, Pariani N, Gallo D, Azzolini C, Ferrario M, Bartalena L (2013) Prevalence and natural history of Graves’ orbitopathy in a large series of patients with newly diagnosed graves’ hyperthyroidism seen at a single center. J Clin Endocrinol Metab 98:1443–1449

    Article  CAS  PubMed  Google Scholar 

  19. Marcocci C, Kahaly GJ, Krassas GE, Bartalena L, Prummel M, Stahl M, European Group on Graves’ Orbitopathy et al (2011) Selenium and the course of mild Graves’ orbitopathy. N Engl J Med 364:1920–1931

    Article  CAS  PubMed  Google Scholar 

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Correspondence to P. Anagnostis.

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Anagnostis, P., Boboridis, K., Adamidou, F. et al. Natural course of mild Graves’ orbitopathy: is it a chronic remitting or a transient disease?. J Endocrinol Invest 40, 257–261 (2017). https://doi.org/10.1007/s40618-016-0555-0

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  • DOI: https://doi.org/10.1007/s40618-016-0555-0

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