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

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 six were randomized controlled trials. The studies varied greatly in methodological rigor; whilst major treatments such as surgery do improve quality of life outcomes, other noninvasive treatments such as intravenous steroids can have a similar impact and show long-term benefits. Only three 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 of the influence of psychosocial factors on quality of life outcomes and the lack of a relationship with clinical factors such as disease severity.