ABSTRACT
The natural history of Graves’ orbitopathy (GO) is incompletely understood but it is well established that severe forms of the disease are encountered in no more than 35% of patients (1). Genetic predisposition to GO, extensively studied especially for human leukocyte antigen associations, has so far been poorly characterized, and discrepant results have been reported (2). The disease tends to be more severe in older patients, and men tend to be more severely affected than women. The overall age-adjusted incidence rate in a population-based cohort study in Minnesota was 16 cases per
100,000 population=year for women, 2.9 cases per 100,000 population=year for men (3). Most interestingly, the disease seems less common and severe than in the past. Perros and Kendall-Taylor (4) reviewed the clinical records of the first 100 consecutive patients diagnosed as having Graves’ disease at the beginning of each decade (1960-1990) at their large thyroid clinic. They found a significant decrease in the prevalence of relevant eye manifestations from 57% in 1960 to 35% in 1990; likewise, there was also a decline in the prevalence of the severe forms of the disease. The reason for this trend is unclear but it is conceivable that, on one hand, the earlier diagnosis of hyperthyroidism and its prompter correction by the endocrinologist, and, on the other hand, the increased attention of the ophthalmologist to the possible link between initial and mild ocular changes and thyroid dysfunction, may account for this variation.
