Abstract
Background: Facial disfigurement of Graves? orbitopathy (GO) is accompanied by restrictions in private and professional life. Aim of this prospective study was to determine the relationship between ocular findings, thyroid function and autoantibodies, quality of life, and working ability in GO.
Methods: On the same day, 250 consecutive outpatients with GO underwent complete thyroid and ophthalmic assessment and answered two questionnaires dealing with quality of life and socioeconomic aspects. The disease specific GO-quality of life (GO-QoL) questionnaire consisted of two subscales, evaluating either visual functioning (VF) or physical appearance (AP). The answers were transformed into two total scores from 0 to 100 with higher values indicating better quality of life.
Results: 231 GO patients (92.4%), and 12 (4.8%) had Graves? disease and Hashimoto?s thyroiditis, respectively. There was no thyroid involvement in 7 (2.8%) cases. Optic neuropathy and diplopia were present in 20 (8%) and 79 patients (31.6%), respectively. 21.2% GO subjects were incapacitated for work, 4% had to retire early, and 2% had been fired. 4.8% were on sick-leave permanently, 7.2% at least for 2 months yearly. Being on sick-leave and incapacitated for work both correlated with diplopia (p<0.001). 20.8% were getting psychotherapy. QoL-scores correlated both with being able to work and with psychotherapy. VF-Score was low in patients with inflammatory GO (p><0.001). Also, the AP-score was reduced both in severe GO as well as in patients with marked proptosis (p><0.001, respectively). High TSH-receptor-antibodies were present in active and/or severe GO (p><0.001) and negatively correlated with AP-scores (r= -0.162, p=0.010). No relationship between thyroid function and GO-QoL was noted.
Conclusions: Measuring QoL and evaluating socioeconomic aspects illustrate patients?psychosocial morbidity, and usefully support clinical and laboratory objective assessment of GO. Thus optimally, complete psychosocial care of GO patients should be ensured in a multidisciplinary joint thyroid eye clinic.