source: Thyroid

year: 2018

authors: W Pinto, D Villagelin, RB Santos, N Perini, A Fontanesi Oliveira, C Zampieri, H Paranhos Louback, L Santos Caleffi, W Muller Ferreira Tirapani, J Hamilton Romaldini

Graves’ orbitopathy (GO) is the most common extrathyroidal manifestation of Graves’ disease (GD). According to Rundle’s curve, GO is characterized by an initial phase of increasing activity (inflammatory phase), a severity peak, and a stable plateau phase (fibrotic phase). This overview has an implication in GO therapeutics. Different patterns that are still distinct from Rundle’s curve have not yet been described.

There were 567 patients with GD from a single clinical center, who were analyzed according to the Clinical Activity Score (CAS) for GO activity. GO evolution was evaluated every 6 months using the CAS.  The patients were divided into 2 groups according to the GO evolution: Group 1 (G1): patients who follow Rundle curve; Group 2 (G2): patients whose characteristics followed GO improvement and worsening over time. Follow-up in both groups was seen at 60 months.

From 567 initial patients, 204 patients were included. G1 (n = 132), mean (– SD), age at diagnosis was 39 – 11 years, 80% were female, with smoking present in 36% of patients. TSH and free T4 were 0.014 – 0.026 IU/mL and 4.40 – 2.09 ng/dL, respectively. Thyrotropin receptor antibodies (TRAb) were positive in 84% patients. In G2 (n = 72), age at diagnosis was 41 – 11 years, 73% were female, and smoking was present in 51% of patients. TSH and free T4 were 0.017 – 0.031 IU/mL and 3.92 – 1.82 ng/dL, respectively. TRAb were positive in 85% patients. Both groups had similar characteristics except for smoking (p < 0.05).

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