Differences in Graves' orbitopathy between hyperthyroid and hypothyroid/euthyroid patients
Biljana Beleslin, Jasmina Ciric, Milos Zarkovic, Mirjana Stojkovic, Slavica Ciric, Miroslav Knezevic & Bozo Trbojevic
Aim: The aim of this study was to compare clinical symptoms and TSH receptor antibodies (TRAb) in Graves orbitopathy (GO) in hyperthyroid patients to those patients with primarily hypothyroid and euthyroid status.
Methods: Study group consisted of 54 primarily hyperthyroid (39 female, 14 male, 47±9 years) and 8 primarily hypothyroid and euthyroid patients (5 female, 3 male, 46±14 years). Clinical symptoms and TRAb were assessed. Assessment of the activity and severity of GO was carried out according to the proposed criteria of the European group on GO.
Results: CAS score was lower in hypothyroid/euthyroid patients than in hyperthyroid but not significantly (4.3 vs 3.6, P=ns). There was no differences in rate of diplopia, visual acuity and intraocular pressure between groups. On the other hand, there was a trend towards more asymmetrical presentation of GO in patients who were hypo/euthyroid (proptosis OD vs OS: 20.4 vs 22.3, P=0.08) than in hyperthyroid patients (proptosis OD vs OS: 21.7 vs. 21.8, P=ns). TRAb levels were significantly lower in hypothyroid/euthyroid patients than in hyperthyroid (2.5 vs 16.3 IU/l, P=0.002).
Conclusion: Those findings of lower levels of TRAb and more asymmetrical presentation of GO in hypothyroid/euthyroid patients could be helpful in clinical practice, especially differential diagnosis of GO.