Skip to main content
Top
Published in: Orphanet Journal of Rare Diseases 1/2017

Open Access 01-12-2017 | Position statement

Graves’ orbitopathy as a rare disease in Europe: a European Group on Graves’ Orbitopathy (EUGOGO) position statement

Authors: P. Perros, L. Hegedüs, L. Bartalena, C. Marcocci, G. J. Kahaly, L. Baldeschi, M. Salvi, J. H. Lazarus, A. Eckstein, S. Pitz, K. Boboridis, P. Anagnostis, G. Ayvaz, A. Boschi, T. H. Brix, N. Currò, O. Konuk, M. Marinò, A. L. Mitchell, B. Stankovic, F. B. Törüner, G. von Arx, M. Zarković, W. M. Wiersinga

Published in: Orphanet Journal of Rare Diseases | Issue 1/2017

Login to get access

Abstract

Background

Graves’ orbitopathy (GO) is an autoimmune condition, which is associated with poor clinical outcomes including impaired quality of life and socio-economic status. Current evidence suggests that the incidence of GO in Europe may be declining, however data on the prevalence of this disease are sparse. Several clinical variants of GO exist, including euthyroid GO, recently listed as a rare disease in Europe (ORPHA466682).
The objective was to estimate the prevalence of GO and its clinical variants in Europe, based on available literature, and to consider whether they may potentially qualify as rare. Recent published data on the incidence of GO and Graves’ hyperthyroidism in Europe were used to estimate the prevalence of GO. The position statement was developed by a series of reviews of drafts and electronic discussions by members of the European Group on Graves’ Orbitopathy. The prevalence of GO in Europe is about 10/10,000 persons. The prevalence of other clinical variants is also low: hypothyroid GO 0.02–1.10/10,000; GO associated with dermopathy 0.15/10,000; GO associated with acropachy 0.03/10,000; asymmetrical GO 1.00–5.00/10,000; unilateral GO 0.50–1.50/10,000.

Conclusion

GO has a prevalence that is clearly above the threshold for rarity in Europe. However, each of its clinical variants have a low prevalence and could potentially qualify for being considered as a rare condition, providing that future research establishes that they have a distinct pathophysiology. EUGOGO considers this area of academic activity a priority.
Literature
3.
go back to reference Ponto KA, Merkesdal S, Hommel G, Pitz S, Pfeiffer N, Kahaly GJ. Public health relevance of Graves’ orbitopathy. J Clin Endocrinol Metab. 2013;98:145–52.CrossRefPubMed Ponto KA, Merkesdal S, Hommel G, Pitz S, Pfeiffer N, Kahaly GJ. Public health relevance of Graves’ orbitopathy. J Clin Endocrinol Metab. 2013;98:145–52.CrossRefPubMed
4.
go back to reference Brandt F, Thvilum M, Almind D, Christensen K, Green A, Hegedüs L, et al. Morbidity before and after the diagnosis of hyperthyroidism: a nationwide register-based study. PLoS One. 2013;8:e66711.CrossRefPubMedPubMedCentral Brandt F, Thvilum M, Almind D, Christensen K, Green A, Hegedüs L, et al. Morbidity before and after the diagnosis of hyperthyroidism: a nationwide register-based study. PLoS One. 2013;8:e66711.CrossRefPubMedPubMedCentral
5.
go back to reference McKeag D, Lane C, Lazarus JH, Baldeschi L, Boboridis K, Dickinson AJ, et al. European Group on Graves’ Orbitopathy (EUGOGO). Clinical features of dysthyroid optic neuropathy: a European Group on Graves’ Orbitopathy (EUGOGO) survey. Br J Ophthalmol. 2007;91:455–8.CrossRefPubMed McKeag D, Lane C, Lazarus JH, Baldeschi L, Boboridis K, Dickinson AJ, et al. European Group on Graves’ Orbitopathy (EUGOGO). Clinical features of dysthyroid optic neuropathy: a European Group on Graves’ Orbitopathy (EUGOGO) survey. Br J Ophthalmol. 2007;91:455–8.CrossRefPubMed
6.
7.
go back to reference Bartalena L, Fatourechi V. Extrathyroidal manifestations of Graves’ disease: a 2014 update. J Endocrinol Invest. 2014;37:691–700.CrossRefPubMed Bartalena L, Fatourechi V. Extrathyroidal manifestations of Graves’ disease: a 2014 update. J Endocrinol Invest. 2014;37:691–700.CrossRefPubMed
9.
go back to reference Melcescu E, Horton WB, Kim D, Vijayakumar V, Corbett JJ, Crowder KW, et al. Graves orbitopathy: update on diagnosis and therapy. South Med J. 2014;107:34–43.CrossRefPubMed Melcescu E, Horton WB, Kim D, Vijayakumar V, Corbett JJ, Crowder KW, et al. Graves orbitopathy: update on diagnosis and therapy. South Med J. 2014;107:34–43.CrossRefPubMed
10.
go back to reference Bartalena L. Graves’ Orbitopathy: Imperfect Treatments for a Rare Disease. Eur Thyr J. 2013;2:259–69.CrossRef Bartalena L. Graves’ Orbitopathy: Imperfect Treatments for a Rare Disease. Eur Thyr J. 2013;2:259–69.CrossRef
11.
go back to reference Tanda ML, Piantanida E, Liparulo L, Veronesi G, Lai A, Sassi L, et al. Prevalence and natural history of Graves’ orbitopathy in a large series of patients with newly diagnosed graves’ hyperthyroidism seen at a single center. J Clin Endocrinol Metab. 2013;98:1443–9.CrossRefPubMed Tanda ML, Piantanida E, Liparulo L, Veronesi G, Lai A, Sassi L, et al. Prevalence and natural history of Graves’ orbitopathy in a large series of patients with newly diagnosed graves’ hyperthyroidism seen at a single center. J Clin Endocrinol Metab. 2013;98:1443–9.CrossRefPubMed
12.
go back to reference Wiersinga WM. Combined Thyroid-Eye Clinics in the Management of Graves’ Ophthalmopathy. In: Bahn RS, editor. Graves’ Disease. New York: Springer; 2015. p. 187–94.CrossRef Wiersinga WM. Combined Thyroid-Eye Clinics in the Management of Graves’ Ophthalmopathy. In: Bahn RS, editor. Graves’ Disease. New York: Springer; 2015. p. 187–94.CrossRef
13.
go back to reference Polizzi A, Balsamo A, Bal MO, Taruscio D. Rare diseases research and practice. Endocr Dev. 2014;27:234–56.PubMed Polizzi A, Balsamo A, Bal MO, Taruscio D. Rare diseases research and practice. Endocr Dev. 2014;27:234–56.PubMed
14.
go back to reference Perros P, Dayan C, Dickinson AJ, Ezra DG, Hickey JL, Hintschisch C, et al. Future research in Graves’ orbitopathy: from priority setting to trial design through patient and public involvement. Thyroid. 2015;25:1181–4.CrossRefPubMedPubMedCentral Perros P, Dayan C, Dickinson AJ, Ezra DG, Hickey JL, Hintschisch C, et al. Future research in Graves’ orbitopathy: from priority setting to trial design through patient and public involvement. Thyroid. 2015;25:1181–4.CrossRefPubMedPubMedCentral
15.
16.
go back to reference Perros P, Žarković M, Azzolini C, Ayvaz G, Baldeschi L, Bartalena L, et al. PREGO (presentation of Graves’ orbitopathy) study: changes in referral patterns to European Group On Graves’ Orbitopathy (EUGOGO) centres over the period from 2000 to 2012. Br J Ophthalmol. 2015;99:1531–5.CrossRefPubMed Perros P, Žarković M, Azzolini C, Ayvaz G, Baldeschi L, Bartalena L, et al. PREGO (presentation of Graves’ orbitopathy) study: changes in referral patterns to European Group On Graves’ Orbitopathy (EUGOGO) centres over the period from 2000 to 2012. Br J Ophthalmol. 2015;99:1531–5.CrossRefPubMed
17.
go back to reference Weetman AP, Wiersinga WM. Current management of thyroid-associated ophthalmopathy in Europe. Results of an international survey. Clin Endocrinol (Oxf). 1998;49:21–8.CrossRef Weetman AP, Wiersinga WM. Current management of thyroid-associated ophthalmopathy in Europe. Results of an international survey. Clin Endocrinol (Oxf). 1998;49:21–8.CrossRef
18.
go back to reference Abraham-Nordling M, Byström K, Törring O, Lantz M, Berg G, Calissendorff J, et al. Incidence of hyperthyroidism in Sweden. Eur J Endocrinol. 2011;165:899–905.CrossRefPubMed Abraham-Nordling M, Byström K, Törring O, Lantz M, Berg G, Calissendorff J, et al. Incidence of hyperthyroidism in Sweden. Eur J Endocrinol. 2011;165:899–905.CrossRefPubMed
19.
go back to reference Zaletel K, Gaberscek S, Pirnat E. Ten-year follow-up of thyroid epidemiology in Slovenia after increase in salt iodization. Croat Med J. 2011;52:615–21.CrossRefPubMedPubMedCentral Zaletel K, Gaberscek S, Pirnat E. Ten-year follow-up of thyroid epidemiology in Slovenia after increase in salt iodization. Croat Med J. 2011;52:615–21.CrossRefPubMedPubMedCentral
20.
go back to reference Laurberg P, Berman DC, Bülow Pedersen I, Andersen S, Carlé A. Incidence and clinical presentation of moderate to severe graves’ orbitopathy in a Danish population before and after iodine fortification of salt. J Clin Endocrinol Metab. 2012;97:2325–32.CrossRefPubMedPubMedCentral Laurberg P, Berman DC, Bülow Pedersen I, Andersen S, Carlé A. Incidence and clinical presentation of moderate to severe graves’ orbitopathy in a Danish population before and after iodine fortification of salt. J Clin Endocrinol Metab. 2012;97:2325–32.CrossRefPubMedPubMedCentral
21.
go back to reference Keiding N. Age-Specific Incidence and Prevalence: A Statistical Perspective. J R Stat Soc Ser A Stat Soc. 1991;154:371–412.CrossRef Keiding N. Age-Specific Incidence and Prevalence: A Statistical Perspective. J R Stat Soc Ser A Stat Soc. 1991;154:371–412.CrossRef
22.
23.
go back to reference Kruijshaar ME, Barendregt JJ, Hoeymans N. The use of models in the estimation of disease epidemiology. Bull World Health Organ. 2002;80:622–8.PubMedPubMedCentral Kruijshaar ME, Barendregt JJ, Hoeymans N. The use of models in the estimation of disease epidemiology. Bull World Health Organ. 2002;80:622–8.PubMedPubMedCentral
25.
go back to reference Brandt F, Almind D, Christensen K, Green A, Brix TH, Hegedüs L. Excess mortality in hyperthyroidism: The influence of preexisting comorbidity and genetic confounding: A Danish nationwide register-based cohort study of twins and singletons. J Clin Endocrinol Metab. 2012;97:4123–9.CrossRefPubMedPubMedCentral Brandt F, Almind D, Christensen K, Green A, Brix TH, Hegedüs L. Excess mortality in hyperthyroidism: The influence of preexisting comorbidity and genetic confounding: A Danish nationwide register-based cohort study of twins and singletons. J Clin Endocrinol Metab. 2012;97:4123–9.CrossRefPubMedPubMedCentral
26.
go back to reference Vanderpump MP, Tunbridge WM, French JM, Appleton D, Bates D, Clark F, et al. The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham Survey. Clin Endocrinol (Oxf). 1995;43:55–68.CrossRef Vanderpump MP, Tunbridge WM, French JM, Appleton D, Bates D, Clark F, et al. The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham Survey. Clin Endocrinol (Oxf). 1995;43:55–68.CrossRef
27.
go back to reference Berglund J, Ericsson UB, Hallengren B. Increased incidence of thyrotoxicosis in Malmö during the years 1988–90 as compared to the years 1970–74. J Intern Med. 1996;239:57–62.CrossRefPubMed Berglund J, Ericsson UB, Hallengren B. Increased incidence of thyrotoxicosis in Malmö during the years 1988–90 as compared to the years 1970–74. J Intern Med. 1996;239:57–62.CrossRefPubMed
28.
go back to reference Flynn RW, MacDonald TM, Morris AD, Jung RT, Leese GP. The thyroid epidemiology, audit and research study: thyroid dysfunction in the general population. J Clin Endocrinol Metab. 2004;89:3879–84.CrossRefPubMed Flynn RW, MacDonald TM, Morris AD, Jung RT, Leese GP. The thyroid epidemiology, audit and research study: thyroid dysfunction in the general population. J Clin Endocrinol Metab. 2004;89:3879–84.CrossRefPubMed
29.
go back to reference Termote K, Decallonne B, Mombaerts I. The influence of prior hyperthyroidism on euthyroid Graves’ Ophthalmopathy. J Ophthalmol. 2014;22:426898. Termote K, Decallonne B, Mombaerts I. The influence of prior hyperthyroidism on euthyroid Graves’ Ophthalmopathy. J Ophthalmol. 2014;22:426898.
30.
go back to reference Eckstein AK, Glowacka D, Mann K, Esser J, Morgenthaler NG. Euthyroid and primarily hypothyroid patients develop milder and significantly more asymmetrical Graves ophthalmopathy. Br J Ophthalmol. 2009;93:1052–6.CrossRefPubMed Eckstein AK, Glowacka D, Mann K, Esser J, Morgenthaler NG. Euthyroid and primarily hypothyroid patients develop milder and significantly more asymmetrical Graves ophthalmopathy. Br J Ophthalmol. 2009;93:1052–6.CrossRefPubMed
31.
go back to reference Khoo DH, Eng PH, Ho SC, Morgenthaler NG, Seah LL, Chee SP, et al. Graves’ ophthalmopathy in the absence of elevated free thyroxine and triiodothyronine levels: prevalence, natural history, and thyrotropin receptor antibody levels. Thyroid. 2000;10:1093–100.CrossRefPubMed Khoo DH, Eng PH, Ho SC, Morgenthaler NG, Seah LL, Chee SP, et al. Graves’ ophthalmopathy in the absence of elevated free thyroxine and triiodothyronine levels: prevalence, natural history, and thyrotropin receptor antibody levels. Thyroid. 2000;10:1093–100.CrossRefPubMed
32.
go back to reference Li Y, Kim J, Diana T, Klasen R, Olivo PD, Kahaly GJ. A novel bioassay for anti-thyrotrophin receptor autoantibodies detects both thyroid-blocking and stimulating activity. Clin Exp Immunol. 2013;173:390–7.CrossRefPubMedPubMedCentral Li Y, Kim J, Diana T, Klasen R, Olivo PD, Kahaly GJ. A novel bioassay for anti-thyrotrophin receptor autoantibodies detects both thyroid-blocking and stimulating activity. Clin Exp Immunol. 2013;173:390–7.CrossRefPubMedPubMedCentral
33.
go back to reference Ponto KA, Binder H, Diana T, Matheis N, Otto AF, Pitz S, et al. Prevalence, phenotype, and psychosocial well-being in euthyroid/hypothyroid thyroid-associated orbitopathy. Thyroid. 2015;25:942–8.CrossRefPubMed Ponto KA, Binder H, Diana T, Matheis N, Otto AF, Pitz S, et al. Prevalence, phenotype, and psychosocial well-being in euthyroid/hypothyroid thyroid-associated orbitopathy. Thyroid. 2015;25:942–8.CrossRefPubMed
34.
go back to reference Soroudi AE, Goldberg RA, McCann JD. Prevalence of asymmetric exophthalmos in Graves’ orbitopathy. Ophthalmic Plast Reconstr Surg. 2004;20:224–5.CrossRef Soroudi AE, Goldberg RA, McCann JD. Prevalence of asymmetric exophthalmos in Graves’ orbitopathy. Ophthalmic Plast Reconstr Surg. 2004;20:224–5.CrossRef
35.
go back to reference Wiersinga WM, Bleumink M, Saeed P, Baldeschi L, Prummel MF. Is sleeping position related to asymmetry in bilateral Graves’ ophthalmopathy? Thyroid. 2008;18:541–4.CrossRefPubMed Wiersinga WM, Bleumink M, Saeed P, Baldeschi L, Prummel MF. Is sleeping position related to asymmetry in bilateral Graves’ ophthalmopathy? Thyroid. 2008;18:541–4.CrossRefPubMed
36.
go back to reference Bartley GB. The epidemiologic characteristics and clinical course of ophthalmopathy associated with autoimmune thyroid disease in Olmsted County, Minnesota. Trans Am Ophthalmol Soc. 1994;92:477–588.PubMedPubMedCentral Bartley GB. The epidemiologic characteristics and clinical course of ophthalmopathy associated with autoimmune thyroid disease in Olmsted County, Minnesota. Trans Am Ophthalmol Soc. 1994;92:477–588.PubMedPubMedCentral
37.
go back to reference Prummel MF, Bakker A, Wiersinga WM, Baldeschi L, Mourits MP, Kendall-Taylor P, et al. Multi-center study on the characteristics and treatment strategies of patients with Graves’ orbitopathy: the first European Group on Graves’ Orbitopathy experience. Eur J Endocrinol. 2003;148:491–5.CrossRefPubMed Prummel MF, Bakker A, Wiersinga WM, Baldeschi L, Mourits MP, Kendall-Taylor P, et al. Multi-center study on the characteristics and treatment strategies of patients with Graves’ orbitopathy: the first European Group on Graves’ Orbitopathy experience. Eur J Endocrinol. 2003;148:491–5.CrossRefPubMed
38.
go back to reference Daumerie C, Duprez T, Boschi A. Long-term multidisciplinary follow-up of unilateral thyroid-associated orbitopathy. Eur J Intern Med. 2008;19:531–6.CrossRefPubMed Daumerie C, Duprez T, Boschi A. Long-term multidisciplinary follow-up of unilateral thyroid-associated orbitopathy. Eur J Intern Med. 2008;19:531–6.CrossRefPubMed
39.
go back to reference Bartalena L, Chiovato L. Graves’-like orbitopathy: do not forget IgG4-related disease. J Endocrinol Invest. 2014;37:1233–5.CrossRefPubMed Bartalena L, Chiovato L. Graves’-like orbitopathy: do not forget IgG4-related disease. J Endocrinol Invest. 2014;37:1233–5.CrossRefPubMed
40.
go back to reference Tiegs-Heiden CA, Eckel LJ, Hunt CH, Diehn FE, Schwartz KM, Kallmes DF, et al. Immunoglobulin G4-related disease of the orbit: imaging features in 27 patients. AJNR Am J Neuroradiol. 2014;35:1393–7.CrossRefPubMed Tiegs-Heiden CA, Eckel LJ, Hunt CH, Diehn FE, Schwartz KM, Kallmes DF, et al. Immunoglobulin G4-related disease of the orbit: imaging features in 27 patients. AJNR Am J Neuroradiol. 2014;35:1393–7.CrossRefPubMed
41.
go back to reference Bartley GB, Fatourechi V, Kadrmas EF, Jacobsen SJ, Ilstrup DM, Garrity JA, et al. Long-term follow-up of Graves ophthalmopathy in an incidence cohort. Ophthalmology. 1996;103:958–62.CrossRefPubMed Bartley GB, Fatourechi V, Kadrmas EF, Jacobsen SJ, Ilstrup DM, Garrity JA, et al. Long-term follow-up of Graves ophthalmopathy in an incidence cohort. Ophthalmology. 1996;103:958–62.CrossRefPubMed
42.
go back to reference Terwee C, Wakelkamp I, Tan S, Dekker F, Prummel MF, Wiersinga W. Long-term effects of Graves’ ophthalmopathy on health-related quality of life. Eur J Endocrinol. 2002;146:751–7.CrossRefPubMed Terwee C, Wakelkamp I, Tan S, Dekker F, Prummel MF, Wiersinga W. Long-term effects of Graves’ ophthalmopathy on health-related quality of life. Eur J Endocrinol. 2002;146:751–7.CrossRefPubMed
44.
go back to reference Aymé S, Bellet B, Rath A. Rare diseases in ICD11: making rare diseases visible in health information systems through appropriate coding. Orphanet J Rare Dis. 2015;10:35.CrossRefPubMedPubMedCentral Aymé S, Bellet B, Rath A. Rare diseases in ICD11: making rare diseases visible in health information systems through appropriate coding. Orphanet J Rare Dis. 2015;10:35.CrossRefPubMedPubMedCentral
Metadata
Title
Graves’ orbitopathy as a rare disease in Europe: a European Group on Graves’ Orbitopathy (EUGOGO) position statement
Authors
P. Perros
L. Hegedüs
L. Bartalena
C. Marcocci
G. J. Kahaly
L. Baldeschi
M. Salvi
J. H. Lazarus
A. Eckstein
S. Pitz
K. Boboridis
P. Anagnostis
G. Ayvaz
A. Boschi
T. H. Brix
N. Currò
O. Konuk
M. Marinò
A. L. Mitchell
B. Stankovic
F. B. Törüner
G. von Arx
M. Zarković
W. M. Wiersinga
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Orphanet Journal of Rare Diseases / Issue 1/2017
Electronic ISSN: 1750-1172
DOI
https://doi.org/10.1186/s13023-017-0625-1

Other articles of this Issue 1/2017

Orphanet Journal of Rare Diseases 1/2017 Go to the issue