Correlation of Quality of Life (QoL) and Self-perception in Patient with Thyroid Eye Disease (TED)

Abstract

Abstract Introduction Tyroid eye disease (TED) is an autoimmune disorder representing the commonest extrathyroidal manifestation of Graves’ disease (GD), with a prevalence of 10 per 10,000 persons in the European population. Although most frequently associated with hyperthyroidism secondary to GD, about 10% of patients with TED are euthyroid or hypothyroid. Patients with Graves orbitopathy (GO) have a significantly lower life quality, both regarding vision problems and worsened appearance, compared to a healthy person. It has been associated with increased rates of anxiety, depression, social isolation and decreased self-confidence. Materials and Methods The results of standard treatments in this disease are often unsatisfactory, but outcomes often do not correlate well with patient reports of how visible they feel their TED is, and the impact on their lives. The present study was designed to correlate QoL and self-perception of well-being with the different clinical and surgical approaches recommended by EUGOGO. The aim is to determine whether there were differences between treatment options in determining patient perception of well-being and satisfaction with treatment received, and whether they would recommend the treatment they had experienced to people with the same condition. Results Scheduled patients undergone medical or surgical treatments based on presence or not of inflammation signs. Evaluation of clinically relevant improvements in each clinical variable was carried out 6 months and one year after treatment. Later, patients were asked a set of general questions about improvement (or worsening) of symptoms, health condition before and after the treatment, degree of limitations of daily activities caused by the pathology, overall satisfaction. After one-year, visual acuity unchanged in all the cases, and exophthalmos’ absolute values improved. Daily activities limitations and heath conditions improved in most patients. In this study we demonstrate that although the majority of patients were satisfied with the treatment they received, patients presenting most severe disease at presentation and received most invasive procedures (such orbital decompression) were less satisfied due to an unrealistic expectation about the impact of surgery on their appearance, including expecting to return to a pre-morbid appearance. Conclusion This study highlights the importance of healthcare professionals eliciting and managing patients’ expectations, in order to optimize surgical outcomes.