Individuals with moderate to severe Graves ophthalmopathy often have significant mood disturbances, according to a new report.

Graves disease triggers an overproduction of hormones from the body’s thyroid gland, a key regulator of metabolism and other vital functions. A small percentage of people with the disorder have a complication called Graves ophthalmopathy, which is characterized by bulging eyes, double vision and other eye problems.

“Disfigurement is often more devastating to patients than functional impairment,” Dr. Don O. Kikkawa from University of California, San Diego, California.

Kikkawa and others measured the prevalence of psychological disturbance resulting from the dysfunction and disfigurement caused by moderate to severe Graves ophthalmopathy, using patients with negligible to very mild Graves ophthalmopathy as controls.

Patients with moderate to severe Graves ophthalmopathy had significantly greater emotional distress levels compared with controls, the authors report.

Patients with proptosis - the forward displacement of the eyeball - experienced significantly more emotional distress than the controls did, but patients with muscle restriction showed no difference with the controls in emotional distress.

“Patients who have noticeable proptosis and/or who have functionally limiting double vision have significant feelings of depression, anger, fatigue, confusion, and reduced vigor compared with patients who have very mild or negligible symptoms,” the investigators report.

In some cases, corrective surgery may be considered, they suggest. “A lower threshold for surgical intervention in patients with significant Graves ophthalmopathy-related mood disturbances might have a significant benefit in quality of life for selected patients,” the authors conclude.

“We plan to obtain the same mood survey from patients who are undergoing surgical rehabilitation for Graves ophthalmopathy to see if there is an improvement in mood state that correlates with surgical intervention,” Kikkawa said. “We also plan to extend our evaluation of psychological disturbances to other ocular disease states because of the profound impact of visual changes.”

SOURCE: Archives of Ophthalmology April 2005.