We read with great interest the recent report by Ponto and associates describing the quality of life of patients with thyroid orbitopathy in a German population. We would like to point out to the readership our belief that the term Graves orbitopathy , as used in this article and throughout the medical literature, is misleading. The authors describe all patients as having Graves orbitopathy, when in fact 94% of the patients had true Graves disease, and the remaining 6% had either euthyroid orbitopathy or Hashimoto-related orbitopathy. This terminology is widespread in the literature and leads to confusion and misdiagnosis among many medical specialties.

Because the term Graves orbitopathy is used so commonly to describe patients with thyroid-associated orbitopathy, many health care professionals erroneously believe that orbitopathy can occur only in patients with Graves hyperthyroidism. However, patients can have thyroid-related orbitopathy in the hypothyroid or euthyroid state as well. Although only observed in a minority of patients, these cases should not be overlooked. The authors have cared for several patients with thyroid orbitopathy who were told inaccurately by referring physicians that their orbital disease was not related to their thyroid gland because “they were not hyperthyroid.”

We suggest that when the thyroid gland causes orbitopathy, different nomenclature be used to avoid ambiguity and clinical pitfalls. We prefer to use thyroid-associated orbitopathy , thyroid orbitopathy , or thyroid eye disease . All three terms correctly describe an orbital condition related to the thyroid gland, without improperly classifying the hormonal state of the patient. If this terminology is used universally, we believe the healthcare community will understand more readily that orbitopathy can result from any thyroid hormonal state, and care of such patients will improve.