Presentation of Graves’ orbitopathy within European Group On Graves’ Orbitopathy (EUGOGO) centres from 2012 to 2019 (PREGO III)

Abstract

BackgroundGraves’ orbitopathy (GO) is subject to epidemiological and care-related changes. Aim of the survey was to identify trends in presentation of GO to the European Group On Graves’ Orbitopathy (EUGOGO) tertiary referral centres and initial management over time.MethodsProspective observational multicentre study. All new referrals with diagnosis of GO within September–December 2019 were included. Clinical and demographic characteristics, referral timelines and initial therapeutic decisions were recorded. Data were compared with a similar EUGOGO survey performed in 2012.ResultsBesides age (mean age: 50.5±13 years vs 47.7±14 years; p 0.007), demographic characteristics of 432 patients studied in 2019 were similar to those in 2012. In 2019, there was a decrease of severe cases (9.8% vs 14.9; p<0.001), but no significant change in proportion of active cases (41.3% vs 36.6%; p 0.217). After first diagnosis of GO, median referral time to an EUGOGO tertiary centre was shorter (2 (0–350) vs 6 (0–552) months; p<0.001) in 2019. At the time of first visit, more patients were already on antithyroid medications (80.2% vs 45.0%; p<0.001) or selenium (22.3% vs 3.0%; p<0.001). In 2019, the initial management plans for GO were similar to 2012, except for lid surgery (2.4% vs 13.9%; p<0.001) and prescription of selenium (28.5% vs 21.0%; p 0.027).ConclusionGO patients are referred to tertiary EUGOGO centres in a less severe stage of the disease than before. We speculate that this might be linked to a broader awareness of the disease and faster and adequate delivered treatment.

Influence of biological sex, age and smoking on Graves’ orbitopathy – a ten-year tertiary referral center analysis

“…In our study the mean age was comparable to other reports (50.3y vs. 50.5y in PREGOIII) ( 35 ). However, the influence of age was less pronounced compared to previous reports.…”

“…In our retrospective analysis of a large single-center cohort female GO patients were much more common as in previous studies and similar to recent reports of tertial referral centers (PREGO III: 79.2% females vs. 82.2% here) ( 35 ). Our evaluation reaffirms the association of male sex with more severe stages of GO ( 18 , 20 – 25 ).…”

“…In our analysis we confirmed the significant association of smoking with a more severe course of GO as reported before in clinical and experimental studies ( 23 , 29 – 31 , 42 ). As in a recent EUGOGO report about a quarter of patients were current smokers (24.2% vs 28% here) ( 35 ). Our multivariate logistic regression showed a significant association but lower Odd’s ratios (OR= 1.2 and 2.1, respectively) compared to Lee et al.…”

“…This might indicate, that RAI is no in general harmful (with sufficient steroid prophylaxis) but should not be considered in patients presenting further risk factors. In our cohort most patients suffered as in previous reports of GD (89% vs 89.9 PREGO III) ( 35 ), whereas hypothyroid and euthyroid cases comprised the remaining 11%. The latter seem not be associated with more severe GO, but might be associated with a delayed diagnosis of GO.…”

In Graves’ disease, thyroid autoantibodies and ultrasound features correlate with distinctive histological features

“…It has been shown that in GD lymphocytic Fig. 4 Histopathological images of mild and severe follicular hyperplasia obtained from GD patients and correlation to laboratory and thyroid volume at ultrasound. An example of mild and one of severe follicular hyperplasia of the thyroid are shown.…”