THE CHRONOLOGY OF GRAVES OPHTHALMOPATHY IN AN INCIDENCE COHORT

PURPOSE: To determine the chronologic characteristics of Graves' ophth almopathy in an incidence cohort of 120 patients. METHODS: We reviewed the community medical records of 120 patients residing in Olmsted Cou nty, Minnesota, in whom Graves' ophthalmopathy had been diagnosed betw een 1976 and 1990. RESULTS: Median age at the time of diagnosis of Gra ves' ophthalmopathy was 43 years; the minimum and maximum ages were 8 and 88 years, respectively. Among 108 patients with hyperthyroidism, o phthalmopathy was diagnosed in the six-month interval preceding the di agnosis of thyroid dysfunction in 20 patients (18.5%); ophthalmopathy was concurrent with the diagnosis of hyperthyroidism in 22 patients (2 0.3%); and ophthalmopathy developed in the six-month interval after th yroid diagnosis in 24 patients (22,2%). Ophthalmopathy was diagnosed m ore than six months before the diagnosis of hyperthyroidism in only fo ur additional patients (3.7%), whereas ocular changes developed six mo nths or more after thyroid disease in the remaining 38 patients (35.2% ). There was no significant seasonal variation in the diagnosis of eit her thyroid dysfunction or ophthalmopathy. Treatment of hyperthyroidis m with iodine-131 did not appear to influence the course of Graves' op hthalmopathy. CONCLUSIONS: There is a strong temporal relationship bet ween the thyroid and eye manifestations of Graves' disease, The diagno sis of Graves' ophthalmopathy tends to follow the diagnosis of hyperth yroidism, Treatment with iodine-131 does not appear to influence the c ourse of Graves' ophthalmopathy. Although both childhood Graves' disea se and Graves' ophthalmopathy are uncommon, ophthalmopathy occurs at a ll ages.