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Clinical Sciences
April 1, 2005

Psychological Disturbance in Graves Ophthalmopathy

Author Affiliations

Author Affiliations: Departments of Ophthalmology (Drs Farid, Roch-Levecq, Levi, Granet, and Kikkawa and Ms Brody), Neurosciences (Dr Levi), and Family and Preventive Medicine (Ms Brody) and the Thyroid Eye Center (Drs Levi, Granet, and Kikkawa), University of California, San Diego. Dr Farid is now with the Department of Ophthalmology, University of California, Irvine.

Arch Ophthalmol. 2005;123(4):491-496. doi:10.1001/archopht.123.4.491

Objective  To study mood disturbance in Graves ophthalmopathy.

Methods  Forty-eight patients (mean age, 55 years; 40 women and 8 men) with Graves ophthalmopathy from a university-based referral center were classified into two groups, 24 with moderate/severe disease (study group) and 24 with negligible/mild disease (control group). The groups were matched with regard to demographic and medical characteristics. All participants completed a mood survey to assess differences in degree of emotional distress.

Main Outcome Measure  The Profile of Mood States survey, a 65-item self-reported inventory designed to assess emotional distress, was the primary outcome measure. A total mood disturbance score was assigned by summing the scores derived on the 6 subscales of the survey—tension, depression, vigor, confusion, fatigue, and anger.

Results  Analysis of variance revealed that patients with moderate/severe Graves ophthalmopathy showed significantly greater emotional distress than patients with mild/negligible Graves ophthalmopathy on the Profile of Mood States mean total score (P<.001). Additionally, patients who had disfigurement (proptosis) as the predominant clinical feature had significantly elevated emotional distress compared with the control group (P = .01), whereas no significant difference was detected between the control group and patients with diplopia as the predominant clinical feature (P = .20).

Conclusion  Patients with moderate to severe Graves ophthalmopathy have significant mood disturbance, especially when disfiguring signs are predominant. We propose that evaluation of the psychological burden of the disease should be considered in routine follow-up and in decisions regarding treatment.