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The psychosocial and clinical outcomes of surgery for Thyroid Eye Disease (TED)

Wickwar, Sadie (2014). The psychosocial and clinical outcomes of surgery for Thyroid Eye Disease (TED). (Unpublished Doctoral thesis, City University London)


This study aimed to investigate whether quality of life in patients with thyroid eye disease (TED) improves as a result of having orbital decompression surgery and whether any demographic, clinical or psychosocial factors can predict which patients might benefit from this surgery.

One hundred and twenty three adults with TED were recruited from Moorfields Eye Hospital (MEH), London. Clinical measurements were taken by the clinical team at MEH and participants completed a range of psychosocial questionnaires prior to surgery and again 6 weeks and 6 months after surgery. The Appearance Research Collaboration’s (ARC) framework of adjustment to living with a disfiguring condition was used to guide the study’s measures and analysis. The Graves’ Ophthalmopathy Quality of Life Questionnaire (GO-QOL; Terwee et al., 1998) was completed by participants at each time point and was the dependent variable in each hierarchical multiple regression model. Semi-structured interviews were conducted with fourteen patients from Birmingham and Midland Eye Centre (BMEC) to explore expectations of orbital decompression and thematic analysis was performed.

Prior to surgery, the regression model explained 55% of the variance in GO-QOL visual function scores and 75% of the variance in GO-QOL appearance scores. Although vision-related quality of life was associated with age and asymmetrical disease, it was intervening psychosocial processes that were more consistently associated with both vision- and appearance-related quality of life. Patients had high expectations for surgery to return them to the “normality” of their lives, and appearance, before TED. High expectations were often a result of great confidence and trust in surgeons and information they had accessed about the surgery online.

Significant improvements were found in all clinical characteristics following surgery and in most psychosocial variables. Vision-related quality of life did not change significantly until 6 months after surgery whilst appearance-related quality of life significantly improved 6 weeks post-surgery and continued to significantly increase 6 months post-surgery reaching a minimal clinically important difference (MCID). Ethnicity and a small number of clinical factors patients presented for surgery were unique predictors of the variance in change in vision-related quality of life and appearance-related quality of life. None of the changes in clinical or psychosocial outcomes significantly predicted change in vision-related quality of life. The hierarchical regression model explained 81% of the variance in change in appearance-related quality of life however, with improvement in personal evaluation of appearance uniquely predicting improvement in appearance-related quality of life.

Further research is required to establish whether expectations are met after surgery. Recommendations for clinical practice include routine psychological assessment and the provision of clear and comprehensible information about surgery. Patients with TED in the future would benefit from interventions targeting the intervening

Publication Type: Thesis (Doctoral)
Subjects: B Philosophy. Psychology. Religion > BF Psychology
Departments: School of Health & Psychological Sciences > Psychology
Doctoral Theses
School of Health & Psychological Sciences > School of Health & Psychological Sciences Doctoral Theses
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