Endocrine Abstracts

JOINT1704

Thyroid Eye Disease (TED) is frequent in Graves’ disease and rare in Hashimoto’ thyroiditis patients, with conjunctival redness, swelling of the eyelids, diplopia and proptosis. TED severely affects the Quality of Life (QoL) of patients, evaluated using visual functioning and physical appearance GO-QoL scores, and higher scores reflecting better QoL. Treatment of TED is based on severity (mild, moderate to severe, sight threatening) and activity (Clinical Activity Score, CAS) of the disease: for active disease (CAS>3/7) intravenous glucocorticoids are the mainstay treatment, for inactive phase (CAS<3/7) surgical rehabilitation (orbital decompression, diplopia correction, eyelid procedures) should improve visual function and esthetic. In our endocrine department, TED patients are seen and managed by a multidisciplinary (endocrinologist, ophthalmologist, maxillo-facial surgeon) team. Of the 136 TED patients evaluated with GO-QoL, 110 were women, mean (±SE) age was 53±1 years and 28 patients presented smoking at diagnosis. Graves’ disease patients (n = 130) were treated with antithyroid drugs, and after recurrence with total thyroidectomy (n = 71) or radioiodine therapy (n = 26). Other patients had autoimmune thyroiditis treated with levothyroxine or clinical followed up. At the active phase, TED patients were treated with intravenous glucocorticoids according to EUGOGO protocol (n = 74), orbital radiotherapy (n = 25) or others medical treatments (rituximab n = 6, tocilizumab n = 4, teprotumumab n = 1). At the inactive phase, surgical rehabilitation consisted of orbital decompression (n = 78), oculomotor surgery (n = 22) and eyelid procedures (n = 26). At the first visit (V1), visual functioning (55.2±2.5) and physical appearance (52.4±2.4) GO-QoL scores were decreased, and negatively associated with the CAS (visual functioning P = 0.001, physical appearance P = 0.03). Physical appearance score was more decreased in women (49.6±2.6) than in men (64.6±4.8) (P = 0.01). Visual functioning and physical appearance scores were more affected in older (P = 0.01) and in younger (P = 0.0001) patients, respectively. At the last visit (V2) after mean 24±1 months of medical and/or surgical follow-up, CAS (V1=2.63±0.13, V2=1.19±0.07, P < 0.001), proptosis (P < 0.0001) and diplopia (V1 n = 81, V2 n = 62, P < 0.0001) decreased, visual functioning (V2=77.5±2.1, P = 0.014) and physical appearance (V2=70.5±2.2, P < 0.01) GO-QoL scores increased significantly, with the exception of physical appearance score in smoking patients (n = 13). In conclusion, visual functioning and physical appearance GO-QoL scores are decreased in TED patients, and improved after medical and/or surgical treatment in our multidisciplinary consultation. GO-QoL scores should be included in the clinical evaluation of TED patients, as severity and activity of the orbital disease, and should be considered as an indicator of treatment results in order to improve QoL of TED patients.