Clinical Characteristics, Disease Activity and Severity of Thyroid Orbitopathy at Presentation to a Tertiary Referral Center

Abstract

Objectives: To present the clinical characteristics of patients with thyroid orbitopathy at initial presentation to a tertiary care center and to determine the disease activity and severity of thyroid orbitopathy at the time of referral.Materials and Methods: This retrospective observational study included 105 right eyes of 105 patients with thyroid orbitopathy (TO) presenting to our clinic between January 2024 and January 2026. On inspection, eyelid retraction and lid lag were evaluated, and margin reflex distance 1 and 2 (MRD1 and MRD2) were measured. Exophthalmometry was performed to determine the amount of proptosis. The Clinical Activity Score (CAS) was calculated based on the presence of spontaneous retrobulbar pain or pain on eye movements, eyelid edema or hyperemia, conjunctival chemosis or hyperemia, and caruncle edema. The EUGOGO classification attempts to assess both disease activity and disease severity.Results: The study population consisted predominantly of female patients, with a comparable age distribution between sexes. All patients had bilateral involvement. Most patients had inactive disease according to the Clinical Activity Score (CAS). However, disease activity differed significantly between sexes, with male patients exhibiting a higher frequency of active disease than female patients. According to the EUGOGO classification, mild disease was the most prevalent severity category, followed by moderate-to-severe and sight-threatening disease. Although sight-threatening disease was numerically more frequent in male patients, no statistically significant sex-related differences were observed across the EUGOGO severity categories.Conclusion: Among TO patients, a substantial proportion of those referred to tertiary care centers had active disease, and male sex was found to be associated with higher clinical activity. These findings emphasize the importance of early diagnosis and timely multidisciplinary evaluation which may aid to reduce disease-related morbidity.