Quality of Life in Patients with Graves' Ophthalmopathy is Markedly Decreased: Measurement by the Medical Outcomes Study Instrument

Abstract

To assess the impact of Graves' ophthalmopathy (GO) on quality of life using a general questionnaire, we performed a descriptive study on consecutive ophthalmopathy patients. We included 70 consecutive, euthyroid patients (age >18 years, 50 females, 20 males, mean +/- SD age 53 +/- 13 years) with varying degrees of severity of GO. General quality of life was assessed with the brief survey (24 questions) from the Medical Outcomes Study (MOS-24), and three subscales of the Sickness Impact Profile (SIP). In comparison with a large published reference group, low scores on the MOS-24 were found. Mean +/- SD scores (difference from reference group) were: physical functioning 58 +/- 31 (-28), role functioning 72 +/- 40 (-15), social functioning 78 +/- 25 (-14), mental health 67 +/- 18 (-10), health perceptions 46 +/- 22 (-26), and bodily pain 68 +/- 28 (-6). MOS-24 and SIP scores did not correlate with the duration, severity, or activity of the ophthalmopathy. In conclusion, we have shown that mild to moderately severe GO has a large influence on the quality of life of these patients. The negative impact on well-being seems not to be related to the usual clinical assessment. These results underscore the need for quality-of-life measurements in clinical trials.

Auto-estima na forma inativa da oftalmopatia de Graves

“…Não houve diferença da auto-estima entre os pacientes dos subgrupos leve e moderado-grave Os dados objetivos nem sempre correspondem com a condição percebida pelo paciente. Pacientes com condições objetivamente idênticas descrevem o seu status de saúde de maneira diferente (3) . Outros estudos com doenças crônicas também encontraram pouca relação entre as medidas clínicas e os resultados dos escores da qualidade de vida (3,(37)(38) .…”

“…Na maioria das vezes está associada à doença de Graves, entretanto, manifestações oculares similares também podem ocorrer, com menor freqüência, em pacientes portadores de tireoidite de Hashimoto, hipotireoidismo ou até mesmo em pacientes eutireoideanos (1)(2) . A enfermidade inicia-se com um processo inflamatório induzido pela reação auto-imune, cuja duração poderá variar de meses a anos, seguindo-se de fase crônica, caracterizada pelo acúmulo de tecido fibroso nos músculos extra-oculares, e também nos tecidos adiposo e conectivo retrobulbar (3)(4) . Dentre os diversos sinais observados poderão estar presentes a proptose, disfunção dos músculos extra-oculares, alterações dos tecidos moles, e também déficit visual por neuropatia compressiva e ceratite por exposição (5) .…”

“…Vários grupos relataram alterações na qualidade de vida dos pacientes com OG tanto nos aspectos físicos como emocionais (3,23) . Sintomas como depressão, ansiedade e estresse relacionados a atividades sociais e de trabalho estão presentes em grande parte dos indivíduos, embora a OG esteja às vezes camuflada em formas de apresentação que podem não parecer graves ao médico (2,24) .…”

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

“…Based on the most frequently observed symptoms and questionnaires found in the international literature (Medical Outcomes Study-24 questionnaire [13]; Short Form-36 questionnaire [14]; EuroQol VAS Questionnaire [15]; National Eye Institute Visual Function Questionnaire [16]; Profile of Mood States [17]; Graves' ophthalmopathy Quality of Life Questionnaire-GOQOL [18]), we developed a questionnaire to measure the HRQOL in patients who had undergone total thyroidectomy for GD. Many of the questions included in our questionnaire were derived from these previously cited studies and were thus considered to be validated.…”

Assessing Graves’ ophthalmopathy-specific quality of life in Korean patients

“…3 The management of GO has been well studied previously, but the impaired quality of life (QOL) caused by GO has been the focus of recent attention. 4 QOL of patients with GO was investigated using a health questionnaire (Medical Outcome Study Short-Form General Health Survey and Sickness Impact Profile) by Gerding et al 4 The study showed little correlation between measures of activity or severity of disease and the scores on the QOL questionnaire. The authors reported that patients with mild or moderately severe GO had similar or worse QOL impairment than patients suffering from heart failure, pulmonary emphysema, or diabetes mellitus.…”