Prevalence and severity of ophthalmic manifestations of Graves’ disease in a tertiary center of North India

Abstract

ABSTRACT Background: Thyroid-associated orbitopathy (TAO) is the most common extrathyroidal manifestation of the systemic autoimmune process known as Graves’ disease (GD). TAO is described as chronic inflammation of orbital and periorbital tissue. The prevalence of Graves’ ophthalmopathy (GO) varies widely in different ethnic groups. Indians have been reported to have a lower prevalence of GO as compared to the West. Purpose: The purpose of the study was to evaluate the prevalence, clinical features, and ocular manifestations in patients with GD. Materials and Methods: This was a hospital-based prospective study done on consecutive 76 newly diagnosed patients of GD documented by thyroid 99mtechnetium pertechnetate scan. Patients were subjected to complete clinical workup and thyroid profile. All patients underwent a comprehensive ophthalmological examination. The diagnosis of TAO was based on the criteria of Bartley and Gorman. Clinical activity score (CAS) and severity were estimated as per the European Group on Graves’ Orbitopathy. Results: TAO was present in 52 (68%) patients with GD. The age of patients ranged from 18 to 68 years, with a mean age of 42.1 ± 11.49 years. The male-to-female ratio was 1:1.6. Eyelid retraction was the most common presentation (78%). Conjunctival redness was seen in 61.5% of patients, followed by eyelid erythema (44.2%), eyelid swelling (32.7%), and plical swelling (23.1%). Almost half of the study group (51.9%) had proptosis of >20 mm. Majority of the patients had mild orbitopathy (65.4%), followed by moderate to severe in 34.6%, and none of the patients showed any signs of sight-threatening disease. None of the patients had a sight-threatening disease. CAS was active in 13.5% of patients. Conclusion: Unlike rest of India, TAO was present in about two-third of patients of GD. Majority of the patients had mild orbitopathy (65.4%).