Clinical Profile of Thyroid Eye Disease and Factors Predictive of Disease Severity in Chennai District of Tamil Nadu

Abstract

Abstract Background: Thyroid eye disease (TED) is a possibly sightthreatening ocular disease generally occurring in the patients diagnosed with hyperthyroidism. TED, also known as Graves orbitopathy, is typically self-limiting auto-immune disease linked with a dysthyroid status. Based on the ocular symptoms and signs, the current grading systems of TED are the VISA classification and the EUGOGO classification; each parameter of VISA score is separately graded and scored. Worsening in any of the VISA parameters is graded as an active disease in the geographic region of South India; there are no studies on clinical profiles of TED; hence, we planned to do this study to analyse the demographic profile and clinical manifestations of TED in patients. Material and Methodology: This study was done as an observational study for a period of 12 months. All patients with systemic thyroid disorder are included in the study. If lid retraction is seen, the presence of laboratory evidence of thyroid dysfunction, exophthalmos, optic nerve dysfunction, or extra ocular muscle involvement will be considered as TED. In case of no lid retraction in a patient with laboratory evidence of thyroid dysfunction, the presence of exophthalmos, optic nerve involvement, or restrictive myopathy will be considered as TED. Patients with diagnosis of TED were further evaluated. TED was graded according to VISA and EUGOGO classification. Results: This study was done as an observational study in 50 patients diagnosed with TED. In our study population, 32 (64%) were hyperthyroid, 11 (22%) were hypothyroidism, and the rest 7 (14%) were euthyroid. The most common presenting complaints were dryness of eye in 46% of patients, followed by blurred vision in 38% of patients. We evaluated severity of disease using EUGOGO score, and 42 patients had mild disease, while six had moderate disease and two patients had severe disease. Based on VISA score, in our study population, only two patients had active disease and the rest 48 had inactive disease. Conclusion: Thyroid status has a direct and positive correlation with active stage of disease and severity. Hyperthyroidism and active disease were risk factors for severe and sight-threatening disease, emphasising the need for close follow-up and prompt detection and management of severe and sight-threatening disease, especially in newly diagnosed hyperthyroid patients. It is important to diagnose TED at the earliest to prevent vision-threatening complications. Early identification and management will help in reducing the severity of disease.