Predictive Factors for Changes in Quality of Life after Steroid Treatment for Active Moderate-to-Severe Graves’ Orbitopathy: A Prospective Trial

Abstract

Objectives: To investigate the predictive factors for changes in the quality of life (GO-QoL) of patients with Graves’ orbitopathy (GO) prior to and after specific treatment. Methods: A prospective follow-up study was conducted at an academic tertiary referral orbital center with a joint thyroid-eye clinic on 100 consecutive patients with GO. Before and after the standard 12-week course of weekly intravenous methylprednisolone (cumulative dose 4.5 g), the GO-QoL questionnaire provided by the European Group on Graves’ Orbitopathy (EUGOGO) was completed. Endocrine and ophthalmic assessments were performed at each visit. Results: All patients were biochemically euthyroid and untreated for GO at baseline and presented with active and moderate-to-severe disease. Both GO-QoL subscales (visual functioning [VF] and appearance [AP]) significantly increased after immunosuppressive therapy and showed a sustained improvement for 6 months. At baseline, demographic variables (sex, age, and smoking) influenced QoL in the stepwise linear regression (p < 0.01, adjusted R² = 0.24 for VF and p < 0.01, adjusted R² = 0.21 for AP). In contrast, 6 months after treatment, the improved QoL was now exclusively associated with ophthalmic parameters (p < 0.01, adjusted R² = 0.47 for VF; p < 0.01, adjusted R² = 0.23 for AP). Conclusions: Predictive factors for GO-QoL differed not only between the 2 subscales but also before and after the first treatment of GO.