This study investigates the incidence of recurrent thyroid eye disease. The authors retrospectively reviewed the records of 415 patients who had been diagnosed with thyroid eye disease between 2006 and 2012. The medical notes were scrutinised for evidence of a previous episode of thyroid eye disease based on a history of prior treatment for thyroid eye disease or significant orbital inflammation. In addition old photographs and previous orbital imaging were reviewed if available. These findings were compared with the patient’s state at their first consultation in the authors’ institution to determine if they were stable or active at that stage. Using this method they retrospectively diagnosed recurrent disease in patients who had active disease at presentation and evidence of another episode of active disease in the past, or those who were stable but had evidence of two or more past active events. Using these criteria they deduced that 65 of the 415 patients had recurrent thyroid eye disease, a rate of 15.7%, much higher than the only other published figure of 5%. They found an average time interval between episodes of 10.3 years. Six patients had suffered multiple recurrences, and patients who were smokers during their first event were at increased risk of reactivation. Periocular surgery was also a risk for recurrence. The authors explain the higher rate was due to the other study including a recurrence only if it occurred after five years of stability, whereas they found 50.8% of recurrences occurred within five years. Although they describe a number of trigger factors, the strongest being periocular surgery, including cataract surgery, they do not compare the incidence of these triggers with patients who did not have a recurrence, casting uncertainty on whether these are genuine risk factors. The study has significant weaknesses in using retrospective analysis of patients’ histories and examinations, and there is conjecture in the discussion and interpretation of the trigger factors. Despite this, there is evidence here that the incidence of recurrent thyroid eye disease is higher than was previously thought. 

Recurrent thyroid eye disease.
Patel P, Khandji J, Kazim M.
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James Hsuan

Aintree University Hospital, Liverpool, UK.

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