Psychological implications of Graves’ orbitopathy

Abstract

Patients with thyroid eye disease, Graves' orbitopathy (GO), often appear distressed and it is likely that features of the condition such as disturbances in visual function, orbital discomfort and alterations in facial appearance can impart significant psychological morbidity upon the patient, which in turn can be detrimental to their quality of life. When considering the psychological impact of GO, two elements of the disease are important. The disfiguring changes to the eyes and face can have a direct effect upon psychological health, while physical aspects of the disease such as altered visual acuity, diplopia, orbital pain and lacrimation may influence psychological function as a secondary phenomenon, due to interference with daily living. Evidence appears to confirm the anecdotal impression of many clinicians dealing with GO patients that the prevalence of psychological morbidity in this patient group is high. A 'biopsychosocial' approach to care that addresses biological and psychosocial functioning as major determinants of health is an appropriate strategy when treating patients with GO.

Does thyroid surgery for Graves’ disease improve health-related quality of life?

“…As a result, our findings may not be fully comparable with those of other studies. However, the lack of a questionnaire that assesses the psychological status, as well as the general, clinical and psychosocial aspects of GD in all its complexity, as well as the response to medical and/or surgical treatment, is acknowledged in the international literature [2,18,28]. Surprisingly, our results showed that none of the patient characteristics were significantly associated with a higher HRQOL impairment after surgery.…”

The patient experience of services for thyroid eye disease in the United Kingdom: results of a nationwide survey

“…3). It is well recognised that TED can have a profoundly negative impact on psychosocial functioning, self-esteem and quality of life (3)(4)(5)(6)(7). Therefore, it is particularly noteworthy that nearly three quarters of the responders felt that they did not receive help to deal with the psychological impact of the disease, and highlight the shortfall in psychological support of this group of patients.…”

“…TED has the potential to cause facial disfigurement and/or visual deficits, impacting on employment, hobbies and self-confidence, and frequently leading to a withdrawal from social interactions. Several previous studies have demonstrated a marked reduction in the quality of life of patients with TED as compared to the general population and patients with other chronic diseases (3)(4)(5)(6), to a degree that is often underappreciated by healthcare professionals.…”

Quality of life in thyroid eye disease: impact of quality of care

“…Although the effect of debilitating clinical manifestations and complexity surrounding the treatment of TED on patients' physical and psychological wellbeing has been well recognised (27,28), the impact of quality of care on these patients' QOL is less discussed. Several surveys of patients with TED and health care professionals involved in the management of this disease have shown evidence for shortcomings in the provision of quality of care, which could contribute to the patients' poor QOL (21,(29)(30)(31)(32)(33).…”