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What are the psychosocial outcomes of treatment for thyroid eye disease? A systematic review

Wickwar, S., McBain, H. B., Ezra, D. G. , Hirani, S. P., Rose, G. E. & Newman, S. P. (2014). What are the psychosocial outcomes of treatment for thyroid eye disease? A systematic review. Thyroid, 24(9), pp. 1407-1418. doi: 10.1089/thy.2014.0037


Background: Thyroid eye disease (TED) causes a number of esthetic and visual problems and its treatment requires close clinical assessment, often for several years. There is evidence to suggest that clinical factors are poor indicators of patient-reported outcomes after treatments that aim to improve appearance, vision, or both. Psychosocial factors can impact on both adjustment to living with TED and also patients’ perceptions of their improvements after treatment. There has been growing recognition that it is essential to evaluate treatment efficacy in terms of psychosocial outcomes but, to date, there has been no review that has systematically evaluated psychosocial outcomes following a variety of treatments for TED.

Summary: Fifteen studies were included in the review and 6 were randomized controlled trials (RCTs). The studies varied greatly in methodological rigor; whilst major treatments such as surgery do improve quality of life outcomes, other non-invasive treatments such as intravenous steroids can have a similar impact and show long-term benefits. Only 3 studies reviewed orbital decompressive surgery which showed better psychosocial outcomes than other types of surgery.

Conclusions: The effect of some treatments remains unclear due to poor methodology and poor reporting of results. Clinicians need to be aware when planning rehabilitative treatments such as surgery the influence of psychosocial factors on quality of life outcomes and the lack of a relationship with clinical factors such as disease severity.

Publication Type: Article
Additional Information: This is a copy of an article published in the THYROID © 2014 [copyright Mary Ann Liebert, Inc.]; THYROID is available online at:
Publisher Keywords: thyroid eye disease, facial disfigurement, psychosocial outcomes, quality of life, treatment, surgery, systematic review
Subjects: R Medicine > RE Ophthalmology
Departments: School of Health & Psychological Sciences > Healthcare Services Research & Management
SWORD Depositor:
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