Cross-sectional study of thyroid associated orbitopathy in a South African thyroid clinic

Abstract

Background: Thyroid-associated ophthalmopathy (TAO) is a common and debilitating manifestation of Graves’ disease (GD) associated with poor clinical outcomes including impaired quality-of-life (QoL) and socio-economic status. Data on TAO in Africa is scarce and unavailable in the South African population.

Methods: This descriptive cross-sectional study focussed on GD patients attending the thyroid clinic at Groote Schuur Hospital, in Cape Town, South Africa. Participants were evaluated for TAO activity and severity according to the European Group on Graves’ Orbitopathy (EUGOGO) criteria. Quality-of-life was assessed using the TED-QoL questionnaire.

Results: Thyroid-associated ophthalmopathy prevalence was 59.8%. The majority of TAO patients had mild disease (n = 73; 59.8%). Based on the severity score alone, moderate to severe disease (n = 41; 33.6%) and sight-threatening disease (n = 8; 6.6%) were identified and referred for further ophthalmological intervention. There was a statistically significant increase in the QoL score with an increase in the severity score (p < 0.05).

Conclusion: The prevalence of orbitopathy was found to be higher than that reported from other continents, but our severity distribution was similar. This study emphasised the importance of evaluating severity as well as the psychosocial aspect of TAO to allow for the identification of and interdisciplinary management of patients to improve patient outcomes.

Contribution: This study was the first to attempt to determine the prevalence and severity of TAO in South Africa. The importance of early TAO detection using both, a clinical and psychosocial tool, is highlighted in this study to reduce the complications associated with TAO.