Evaluation of Quality of Life in the Brazilian Graves' Disease Population: Focus on Mild and Moderate Graves' Orbitopathy Patients

Abstract

Background: Quality of life (QoL) studies in patients with mild to moderate Graves' orbitopathy (GO) are scarce. Methods: The original GO-QoL questionnaire was translated to Portuguese and administered to 323 patients with Graves' disease. The clinically active score (CAS) was used to evaluate GO activity, and the NO SPECS and EUGOGO classifications were used to estimate GO severity. Results: The internal consistency of the GO-QoL, evaluated using Cronbach's alpha, was optimal. In people with Graves' disease and long-duration GO, both visual function and appearance scores were negatively associated with the CAS and NOSPECS and EUGOGO classifications ( P < 0.001). Asymmetry and proptosis were significantly associated with the visual function and appearance domains, and diplopia was related to the visual function score. In addition, multivariate regression stepwise analysis revealed that disease severity, according to the EUGOGO classification, was associated with the visual function and appearance scores; asymmetry, presence of proptosis, and young age were associated with the appearance score ( P < 0.001). The visual function and appearance scores were negatively correlated with the CAS and NOSPECS and EUGOGO classifications ( P < 0.001). Conclusion: Graves' orbitopathy has a negative impact in QoL in patients with mild to moderate disease, even after an extended period, rendering GO a chronic disease. The GO-QoL questionnaire can be helpful in identifying patients in need of attention and support.

Physician-Perceived Impact of Thyroid Eye Disease on Patient Quality of Life in the United States

“…These findings suggest that overall disease severity, rather than any one severity measure, drive physician-perceived QOL impact in patients with TED. This conclusion is supported by patient-perceived QOL studies that show an increased QOL impact in patients with more severe disease [21][22][23][24][25]. On the other hand, eye muscle involvement, and the resulting sequelae (e.g., strabismus and diplopia), have been previously shown to specifically negatively influence QOL in TED patients [10-12, 22, 24].…”

“…To the best of our knowledge, this is the first study of its kind to include information from patients in the USA. Other QOL studies performed in Europe [9][10][11][17][18][19], Asia [20][21][22], Australia [23], and South America [24,25] have also shown a high impact of TED on patients' QOL.…”

Asymmetry indicates more severe and active disease in Graves’ orbitopathy: results from a prospective cross-sectional multicentre study

“…Facial asymmetry is important as it can be a cause of distress to patients [15], including a negative impact on the quality of life in patients with asymmetric GO [16]. Asymmetry is also an intriguing observation in diseases that are thought to be systemic, and further study may provide insights into factors that modulate disease expression.…”

Proposal for Standardization of Primary and Secondary Outcomes in Patients with Active, Moderate-to-Severe Graves’ Orbitopathy

“…The recent CIRTED trial further validated the English version of the GO-QoL [29]. The GO-QoL is now available in 19 languages: Chinese [30][31][32], Danish, Dutch, English, French, Georgian, German [33], Greek, Italian, Korean [34], Persian [35], Polish [36], Portuguese [37], Romanian, Russian, Serbian, Spanish [38], Swedish, and Turkish (some can be downloaded for free from www. eugogo.eu).…”

“…eugogo.eu). Formal validation of the translated versions has been published for the English, Persian, Polish, and Portuguese versions of the GO-QoL [29,[35][36][37]. The GO-QoL finally satisfies feasibility criteria.…”