Predictive score for the development or progression of Graves' orbitopathy in patients with newly diagnosed Graves' hyperthyroidism. Issue 6 (June 2018)

• Record Type: Journal Article
• Authors: Wiersinga, Wilmar; Žarković, Miloš; Bartalena, Luigi; Donati, Simone; Perros, Petros; Okosieme, Onyebuchi; Morris, Daniel; Fichter, Nicole; Lareida, Jurg; von Arx, Georg; Daumerie, Chantal; Burlacu, Maria-Christina; Kahaly, George; Pitz, Susanne; Beleslin, Biljana; Ćirić, Jasmina; Ayvaz, Goksun; Konuk, Onur; Törüner, Füsun Balos̜; Salvi, Mario; Covelli, Danila; Curro, Nicola; Hegedüs, Laszlo; Brix, Thomas
• Is Part Of: European journal of endocrinology. Volume 178:Issue 6(2018)
• Page Start: 635
• Page End: 643
• Publication Date: 2018-06
• Subjects: Endocrinology -- Periodicals; 616.4005
• DOI: 10.1530/EJE-18-0039
• Languages: English
• ISSNs: 0804-4643

Abstract

Abstract : Objective: To construct a predictive score for the development or progression of Graves' orbitopathy (GO) in Graves' hyperthyroidism (GH). Design: Prospective observational study in patients with newly diagnosed GH, treated with antithyroid drugs (ATD) for 18 months at ten participating centers from EUGOGO in 8 European countries. Methods: 348 patients were included with untreated GH but without obvious GO. Mixed effects logistic regression was used to determine the best predictors. A predictive score (called PREDIGO) was constructed. Results: GO occurred in 15% (mild in 13% and moderate to severe in 2%), predominantly at 6–12 months after start of ATD. Independent baseline determinants for the development of GO were clinical activity score (assigned 5 points if score > 0), TSH-binding inhibitory immunoglobulins (2 points if TBII 2–10 U/L, 5 points if TBII > 10 U/L), duration of hyperthyroid symptoms (1 point if 1–4 months, 3 points if >4 months) and smoking (2 points if current smoker). Based on the odds ratio of each of these four determinants, a quantitative predictive score (called PREDIGO) was constructed ranging from 0 to 15 with higher scores denoting higher risk; positive and negative predictive values were 0.28 (95% CI 0.20–0.37) and 0.91 (95% CI 0.87–0.94) respectively. Conclusions: In patients without GO at diagnosis, 15% will develop GO (13% mild, 2% moderate to severe) during subsequent treatment with ATD for 18 months. A predictive score called PREDIGO composed of four baseline determinants was better in predicting those patients who will not develop obvious GO than who will.