Prevalence of ophthalmic manifestations in patients with diffuse toxic goiter in Tehran

Graves’ disease is a very common thyroid disease with ophthalmopathy being the most obvious extrathyroid manifestation of this disease. The ocular changes include proptosis, eyelid edema, conjunctivitis, chemosis, extraocular muscle involvement, corneal ulcer, optic neuritis and blindness. This study was conducted to determine the factors that aggravate the severity and activity of the disease.

This is a descriptive study performed on 117 patients (aged 14 to 74 years) with Graves’ ophthalmopathy, referring to a private endocrine clinic in Tehran, between January and November 2002. Following completion of a questionnaire for each patient, thyroid and ophthalmologic examination were done. The second ophthalmologic examinations was conducted after an interval of one to three months, for evaluation of activity. Correlations between severity and activity with factors such as sex, age, duration of disease, smoking, thyroid function and treatment with Iodine were evaluated.

Evaluation of subjects revealed the following prevalences: lid retraction 91.4% only signs, no symptoms 91.4%, soft tissue swelling 17.9%, proptosis 56.4%, extraocular muscle(EOM) involvement 13.7%, optic neuritis 5.1%, and none had corneal ulcer. EOM involvement was higher in men than in women. (27.8% vs. 7.4%) (P<0.05). The prevalence of active ophthalmopathy was higher in men than in women (69.4% compared to 35.8%) (P<0.001) and lower in patient that had iodine ablation 33.3% vs. 62% (P<0.003). Statistics of subjects seen to have autoimmune disease and family histories of thyroid disease were 8.6% and 47.9% respectively. In both sexes smoking was higher than in the general population (P<0.01).

This study revealed that, as compared to other countries, Graves’ ophthalmopathy is seen to occur almost a decade earlier in the Iranian subjects studied. Individuals aged over 40 and males seen to be more at risk as compared to others.