Quality of Life Studies in Thyroid-Associated Orbitopathy

Quality of life (QoL) has been assessed in patients with thyroid associated orbitopathy (TAO) using qualitative as well as quantitative approaches. Qualitative studies have identified important disease related issues such as challenges due to altered self and impaired visual function. Several questionnaires addressing general health related QoL as well as disease specific QoL have been developed. Most widely used is the Graves Ophthalmopathy-QoL (GO-QOL) questionnaire. It was introduced in 1998 and has since been validated across different cultures. GO-QOL scores correlate to varying degrees with disease activity and severity indicating that the impact of the disease on each patient is highly variable. Factors like the patients’ expectations, coping ability, motivation, social support, and the physician-patient relationship contribute to this discrepancy. Visual function subscale scores are reduced particularly in young individuals and in individuals with extraocular muscle involvement, soft tissue inflammation, and proptosis. Appearance subscale scores are reduced more frequently in females and in individuals with soft tissue inflammation, asymmetry, and proptosis. Studies of QoL coupled with psychosocial assessments have revealed that patients with TAO more frequently suffer from anxiety and depression, have a poorer self-image, have more disturbances in their sleep, social function, and work function, are more likely to have psychotherapy, and are at higher risk for suicide. A minimal clinically important difference in QoL has been established for anti-inflammatory and surgical treatment using the GO-QOL questionnaire. To ensure that the patients’ perspective is maintained, QoL assessment is recommended in everyday clinical practice and in clinical trials.