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There are some important differences in the presentation of GO at different ages and a tendency for overall severity to increase with age, regardless of gender [21].

Children and teenagers with Graves’ disease appear as likely as adults to develop GO, particularly in countries where teenagers are more likely to smoke [see the chapter by Bartalena, this vol., pp. 304–305; 22, 23]. However, unlike adults, they rarely develop severe disease, and the majority will require no specific treatment [24, 25]. They commonly show a degree of eyelid retraction and mild exophthalmos but rarely show muscle restriction, corneal ulceration, or optic neuropathy.

By contrast, some data suggest that patients over 50 years of age are more likely to have impaired motility than those under 50 (32 vs. 12%, respectively) with greater limitation in upgaze [5] while others show no such difference [21]. However studies consistently show a significantly higher risk of optic neuropathy with age [5, 26–28]. This may relate at least partly to a higher prevalence of concomitant vascular disease in older patients.

Older patients are also more likely to have unilateral or very asymmetrical disease and are more likely to be euthyroid or hypothyroid at the time of presentation [5].