Published: 2016-12-29

Prevalence and risk factors of thyroid-associated ophthalmopathy among Indians

Chetan Mathur, Shailendra Singh, Saurabh Sharma


Background: Thyroid-associated ophthalmopathy (TAO) is a part of an autoimmune process that can affect the orbital and periorbital tissue, the thyroid gland, and, rarely, the pretibial skin or digits. The aim of the present study was to determine the prevalence of TAO among Indian patients with thyroid dysfunction and the risk factors associated with TAO.

Methods: A cross-sectional study of thyroid eye disease was conducted on patients with thyroid dysfunction visiting the outpatient department of a tertiary care centre. Demographic data, past medical history, family history, and life-style data were collected from all patients. An ophthalmologist interviewed the patients and noted the presence of symptoms and signs relevant to thyroid eye disease.

Results: Out of a total of 100 patients, who were eligible for analysis, 80 were diagnosed with mild to moderate TAO and 20 were diagnosed with severe TAO. There were more male patients in patients with a severe course (50%) compared to those with a mild to moderate course (42.5%). More patients with a severe course were smokers compared to those with a mild to moderate course (chi-square test, p=0.021). More patients with a severe course had a higher clinical activity score (p=0.007).

Conclusions: We have confirmed that smoking is the strongest risk factor for development of a severe course of TAO in Indian patients. Thus, it is important for patients with Graves' disease to refrain from smoking.


Thyroid associated ophthalmopathy, Hyperthyroidism, Smoking

Full Text:



Ing E, Abuhaleeqa K. Graves' ophthalmopathy; thyroid-associated orbitopathy. Clin Surg Ophthalmol. 2007;25:386-92.

Yeatts RP. Quality of life in patients with Graves ophthalmopathy. Trans Am Ophthalmol Soc. 2005;103:368-411.

Bartalena L, Baldeschi L, Dickinson A, Eckstein A, Kendall-Taylor P, Marcocci C. Consensus statement of the European Group on Graves' orbitopathy (EUGOGO) on management of GO. Eur J Endocrinol. 2008;158(3):273-85.

Bartley GB, Fatourechi V, Kadrmas EF, Jacobsen SJ, Ilstrup DM, Garrity JA, et al. The incidence of Graves' ophthalmopathy in Olmsted County, Minnesota. Am J Ophthalmol. 1995;120(4):511-7.

Nassar MM, Dickinson AJ, Neoh C, Powell C, Buck D, Galal E, et al. Parameters predicting outcomes of strabismus surgery in the management of Graves' ophthalmopathy. J AAPOS. 2009;13(3):236-40.

Ujhelyi B, Erdei A, Galuska L, Varga J, Szabados L, Balazs E, et al. Retrobulbar 99mTc-diethylenetriamine-pentaacetic-acid uptake may predict the effectiveness of immunosuppressive therapy in Graves' ophthalmopathy. Thyroid. 2009;19(4):375-80.

Dolman PJ, Rootman J. VISA Classification for Graves orbitopathy. Ophthal Plast Reconstr Surg. 2006;22:319-24.

Bartalena L, Pinchera A, Marcocci C. Management of Graves' ophthalmopathy: reality and perspectives. Endocr Rev. 2000;21:168-99.

Perros P, Crombie AL, Matthews JN, Kendall-Taylor P. Age and gender influence the severity of thyroid-associated ophthalmopathy: a study of 101 patients attending a combined thyroid-eye clinic. Clin Endocrinol (Oxf). 1993;38:367-72.

Tallstedt L, Lundell G, Taube A. Graves' ophthalmopathy and tobacco smoking. Acta Endocrinol (Copenh). 1993;129:147-50.

Winsa B, Mandahl A, Karlsson FA. Graves' disease, endocrine ophthalmopathy and smoking. Acta Endocrinol (Copenh). 1993;128:156-60.

Thornton J, Kelly SP, Harrison RA, Edwards R. Cigarette smoking and thyroid eye disease: a systematic review. Eye (Lond). 2007;21:1135-45.

Pfeilschifter J, Ziegler R. Smoking and endocrine ophthalmopathy: impact of smoking severity and current vs lifetime cigarette consumption. Clin Endocrinol (Oxf). 1996;45:477-81.

Bartalena L, Marcocci C, Tanda ML, Manetti L, Dell'Unto E, Bartolomei MP, et al. Cigarette smoking and treatment outcomes in Graves ophthalmopathy. Ann Intern Med. 1998;129:632-5.

Burch HB, Wartofsky L. Graves' ophthalmopathy: current concepts regarding pathogenesis and management. Endocr Rev. 1993;14:747-93.

Khoo DH, Ho SC, Seah LL, Fong KS, Tai ES, Chee SP, et al. The combination of absent thyroid peroxidase antibodies and high thyroid-stimulating immunoglobulin levels in Graves' disease identifies a group at markedly increased risk of ophthalmopathy. Thyroid. 1999;9:1175-80.

Gerding MN, vanderMeer JW, Broenink M, Bakker O, Wiersinga WM, Prummel MF, et al. Association of thyrotrophin receptor antibodies with the clinical features of Graves' ophthalmopathy. Clin Endocrinol (Oxf) 2000;52:267-71.