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Patients with hyperthyroidism at greater risk of worse Graves' ophthalmopathy

Br J Ophthalmol. 2009;93(8):1052-1056.

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An overactive thyroid gland may lead to a worse disease course for patients with Graves' ophthalmopathy compared with patients with a normally functioning or underactive thyroid gland.

Hyperthyroidism is well-known to occur concomitantly with Graves' ophthalmopathy, and the prevalence of Graves' ophthalmopathy in euthyroid and hypothyroid patients is between 1.6% and 8.6%, according to a study. However, few studies have charted the actual disease course of Graves' ophthalmopathy in relation to underlying thyroid functionality.

In a population of patients with Graves' ophthalmopathy — 143 with hyperthyroidism, 28 with a normal thyroid and 11 with hypothyroidism — symptoms were more severe in patients with hyperthyroidism, the disease course was more active and there was more asymmetrical disease.

As well, at 6 months after onset of Graves' ophthalmopathy, TSH-receptor antibody (TRAb) levels were significantly lower in euthyroid and hypothyroid patients, as was the prevalence and TRAb and thyroid peroxidase antibodies, according to the study.