Clinical Presentation and Natural History of Graves’ Ophthalmopathy

Graves’ ophthalmopathy (GO) is clinically apparent in about 35% patients with Graves’ disease, but is subclinically present in most patients (8). The presentation of GO is highly variable. None of the clinical signs of GO are pathognomonic, yet this condition is rarely a diagnostic challenge to the experienced clinician. However delays in making the diagnosis by nonspecialists is common. Clinicians managing patients with GO have to decide which aspects of a patient’s presentation warrant referral to a specialist centre. The clinical course of GO through time is multiphasic and spontaneous regression occurs in most patients. The “natural history” of this disease is a concept of critical importance in prognosis, and timing of therapeutic interventions.