Recurrent Thyroid Eye Disease

Purpose: The natural history of thyroid eye disease follows a biphasic course featuring an initial active stage followed by a durable quiescent stage. Reactivation of thyroid eye disease is defined by recurrence of inflammatory signs and symptoms after a period of stability lasting at least 6 months. It is thought to be rare and is poorly studied. The goal of this study was to define the incidence and characteristics of recurrent thyroid eye disease. Methods: A retrospective chart review of 415 visits of patients with thyroid eye disease was performed between 2006 and 2012. Recurrent cases were identified by subjective historical accounts of disease recurrence, review of prior orbital imaging, and photographic evidence. Results: Among 415 cases of thyroid eye disease, 65 cases of recurrence (15.7%) were identified. Most cases of reactivation occurred within the first 10 years after the initial episode of thyroid eye disease. The mean age of patients at the first event was 42.2 years and 52.6 years at the second event. Eighteen patients had identifiable events that may have triggered disease recurrence. The recurrence rate was higher among patients that had been smokers during their first episode of thyroid eye disease (22%) compared with the nonsmokers (14.6%). Conclusions: Although uncommon, recurrence of thyroid eye disease does not appear to be as rare as previously believed. A better understanding of the natural history of thyroid eye disease is important as it impacts patient education and management.