Sex-related disparities in patient-reported quality of life in thyroid eye disease: a domain-specific GO-QOL analysis

Thyroid eye disease (TED) is associated with substantial functional and psychosocial burden, but the independent association between sex and patient-reported quality of life remains incompletely understood. This study assessed sex-related differences in the visual-functioning and appearance-related domains of the Graves’ Ophthalmopathy Quality of Life questionnaire (GO-QOL). This retrospective cross-sectional study included 144 consecutive patients with TED evaluated at a tertiary referral center. The cohort comprised 61 men and 83 women, with a mean age of 54.8 ± 10.2 years. All patients completed the GO-QOL questionnaire during the same clinical visit as a standardized ophthalmic and endocrine assessment. Separate multivariable linear regression models were constructed for the two GO-QOL domains, adjusting for age, TED duration, Clinical Activity Score, exophthalmos, diplopia severity, smoking status, and thyroid functional status. Women had lower unadjusted GO-QOL scores than men in both the visual-functioning domain (85.3 ± 17.7 vs. 93.4 ± 11.1; p = 0.004) and the appearance-related domain (87.6 ± 14.8 vs. 96.1 ± 3.5; p = 0.020). After multivariable adjustment, female sex remained independently associated with lower scores in the visual-functioning domain (β = −4.22; 95% CI, − 7.33 to − 1.11; p = 0.008) and the appearance-related domain (β = −6.60; 95% CI, − 9.30 to − 3.90; p < 0.001). TED duration was not independently associated with either GO-QOL domain. Diplopia severity and hyperthyroid status were strongly associated with lower scores in both domains. Exophthalmos was also independently associated with lower visual-functioning and appearance-related GO-QOL scores. Female sex was independently associated with lower GO-QOL scores in both domains, with a larger association in the appearance-related domain. These findings indicate that conventional clinical measures may not fully capture patient-perceived disease burden and support the integration of disease-specific patient-reported outcomes into routine TED assessment.