16
Graves' Disease
Table 9. Risk Factors for Graves' Orbitopathy
Risk factor
Amenable to
intervention Comments
Age No Advanced age – risk for more severe GO.
Sex No GO is more frequent in women (as GD is);
more severe in men.
Genetics/ Ancestry No Highest prevalence of GO in Caucasians,
lowest in Asians. Immunomodulatory
genes likely involved.
Mechanical factors No Noted wider lateral wall orbital angle in
GO.
TSH receptor antibody
No
a
Predicts GO risk and GO therapy response.
Smoking Yes Increases GO progression and decreases
therapy efficacy. Smoking-cessation clinics
favored for intervention.
yroid dysfunction Yes Need for expeditious control of
hyperthyroidism then prevention of
hypothyroidism post GD therapy.
RAI therapy Yes Risk is additive to smoking ; increased with
preexistent and active GO; preventable by
glucocorticoids 6–12 weeks post RAI.
a
Decreased TRAb noted with methimazole therapy yet available data is unable to separate that
change from the natural history of GO with improving TRAb.
