The evaluation of some severity and activity parameters in Graves' ophthalmopathy
Ioana Zosin1, Melania Balas1, Ioana Golu1, Oana Vonica2, Mihaela Vlad1 & Luiza Badescu3
Aim of the study: The paper presents some clinical and laboratory parameters reflecting activity and severity of Graves ophtalmopathy (GO) and discusses the correlation between them.
Subjects and methods: The study included 25 GO cases, with mean age 47.7±11.2 years and a female/male ratio of 21/4. The patients were evaluated clinically, by assessment of thyroid status (TSH, FT3, FT4, thyrotropin receptor autoantibodies (TRAb)) and by orbital imagistic means (CT or MRI scan). The mean duration of GO was 19.7 months (396 months). The patients were under treatment with antithyroid drugs.
Results: Based on EUGOGO activity and severity criteria, the cases were divided in two subgroups: 16 cases with active ophtalmopathy (4 mild and 12 moderate/severe forms) and 9 cases with inactive disease (5 mild and 4 moderate/severe forms).
The severity of GO was quantified, using EUGOGO recommendations, allotting points for each parameter. Active GO cases showed higher severity scores (right eye: 7.2±2.83; left eye: 5.86±2.74), as compared to inactive cases (right eye: 2.66±2.5, P=0.002; left eye: 2.66±1.86, P=0.01, t-test).
The severity score correlated significantly with clinical activity score (CAS): Pearson correlation index r=0.599, r2=0.313, P=0.008, for right eye, and respectively r=0.547, r2=0.299, P=0.01 for left eye.
Serum TRAb values correlated significantly with CAS in both subgroups of cases, but did not correlate with severity score. None of the cases with inactive GO was present smoker, although among active GO, 7 patiens were active smokers (P=0.02, Fishers exact test). There was no significant correlation between the degree of thyrotoxicosis and CAS or severity scores.
Conclusion: CAS as much as severity parameters are required for a correct evaluation of GO, its prognosis and therapy.