NATURAL-HISTORY OF THYROID-ASSOCIATED OPHTHALMOPATHY

BACKGROUND The natural history of thyroid associated ophthalmopathy is poorly documented, although it is widely thought that many cases impr ove spontaneously with time. This has important implications in the ma nagement of patients and is also a critical factor when assessing the effects of different treatments.OBJECTIVE To document the natural hist ory of thyroid associated ophthalmopathy, 59 patients were studied lon gitudinally and the severity of eye disease documented at regular inte rvals. METHODS Fifty-nine patients with thyroid associated ophthalmopa thy who had not received immunosuppressive or surgical treatment for t heir eye disease, were recruited from a combined thyroid-eye clinic. T hey were assessed at presentation and at 3-6-monthly intervals for a m edian of 12 months. The eyes were assessed by separate and objective m easurements relating to the status of the eyelids, cornea, extraocular muscles, proptosis and optic nerve function. In addition, a scoring s ystem based on the above measurements was used to grade the overall se verity of eye disease. RESULTS Thirteen patients (22%) improved substa ntially, 25 patients (42.4%) showed minor improvement, 13 patients (22 %) did not change, and 8 patients (13.5%) deteriorated progressively, to the extent that immunosuppressive treatment was considered to be ne cessary. CONCLUSIONS A significant proportion of patients with thyroid associated ophthalmopathy (64.4% in the present series) improve spont aneously so serial assessment plays an important part in deciding whic h patients require immunosuppressive treatment. These findings also su pport the view that clinical trials designed to test the efficacy of n ew treatments in thyroid associated ophthalmopathy should be scrupulou sly controlled to allow for the natural tendency towards remission.