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Patients with Graves’ hyperthyroidism and GO are older than those with Graves’ hyperthyroidism without GO (mean age 46.4 and 40.0 years, respectively) [7–9]. The mean age of 152 GO patients referred to EUGOGO centres was 49 years [10].

GO, like Graves’ hyperthyroidism, is more common in women than men. The female-to-male ratio was 9.3 in patients with mild orbitopathy, 3.2 in those with moderate orbitopathy, and 1.4 with severe orbitopathy [1–4].

A sex-related difference in the severity of GO has been noted, with men comprising a relatively greater proportion of cases of severe orbitopathy. Eye disease tends to be more severe in older patients and in men. The reason for this effect of gender is not clear but the higher prevalence of smoking among men likely plays a role.