Association between Graves' ophthalmopathy and smoking

doi:10.1016/0140-6736(90)91315-2

The Lancet

Volume 335, Issue 8700, 26 May 1990, Pages 1261-1263

https://doi.org/10.1016/0140-6736(90)91315-2 Get rights and content

Abstract

Patients with Graves' disease were questioned by postal survey about their smoking history. There were significantly more smokers in the group with ophthalmopathy than in the group with Graves' thyrotoxicosis or controls. Patients with severe eye signs smoked significantly more tobacco than did those with less serious signs.

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Thyroid Eye Disease and its Vision-Threatening Manifestations in the Academy IRIS Registry: 2014-2018
2023, American Journal of Ophthalmology
To evaluate prevalence of thyroid eye disease (TED) and associated factors in the American Academy of Ophthalmology IRIS^Ⓡ Registry (Intelligent Research in Sight).
Cross-sectional analysis of the IRIS Registry.
IRIS Registry patients (18-90 years old) were classified as TED (ICD-9: 242.00, ICD-10: E05.00 on ≥2 visits) or non-TED cases, and prevalence was estimated. Odds ratios (OR) and 95% Confidence Intervals (CIs) were estimated using logistic regression.
41,211 TED patients were identified. TED prevalence was 0.09%, showed a unimodal age distribution (highest prevalence in ages 50-59 years (y) (0.12%)), higher rates in females than males (0.12% vs. 0.04%) and in non-Hispanics than Hispanics (0.10% vs. 0.05%). Prevalence differed by race (from 0.08% in Asians to 0.12% in Black/African-Americans), with varying peak ages of prevalence. Factors associated with TED in multivariate analysis included age: ((18-<30y (reference), 30-39y: OR (95%CI) 2.2 (2.0, 2.4), 40-49y: 2.9 (2.7,3.1), 50-59y: 3.3 (3.1, 3. 5), 60-69y: 2.7 (2.54, 2.85), 70+: 1.5 (1.46, 1.64)); female sex vs male (reference), 3.5 (3.4,3.6), race: White (reference), Blacks: 1.1 (1.1,1.2), Asian: 0.9 (0.8,0.9), Hispanic ethnicity vs not Hispanic (reference), 0.68 (0.6,0.7), smoking status: (never (ref), former: 1.64 (1.6,1.7), current 2.16: (2.1,2.2)) and Type 1 diabetes (yes vs no (reference): 1.87 (1.8, 1.9).
This epidemiologic profile of TED includes new observations such as a unimodal age distribution and racial variation in prevalence. Associations with female sex, smoking, and Type 1 diabetes are consistent with prior reports. These findings raise novel questions about TED in different populations.
The effect of oral statin therapy on strabismus in patients with thyroid eye disease
2018, Journal of AAPOS
Citation Excerpt :
Although they classically exert their main effect on HMG co-A reductase, the enzyme that controls the rate-limiting step in cholesterol production, there is increasing interest in their secondary effects.11,13-15 Statins have been shown in vivo to decrease inflammatory markers such as CRP in cardiology patients,31,32 and they have been shown in vitro to decrease monocyte production of IL-6 and TNF-a,19,21-23,27 both of which are implicated in the development of TAO. Another benefit of statins is their relatively friendly side effect profile, which commonly includes myopathy and elevated liver function tests, and, rarely, complications such as rhabdomyolysis.33
Statins, known to possess anti-inflammatory characteristics, have recently been identified as potentially reducing the risk of developing thyroid eye disease (TED) in Graves disease patients. The current study investigates the effect of oral statin therapy on strabismus related to TED.
This is a retrospective review of patients with a diagnosis of both TED and restrictive strabismus. Oral statin users and nonusers were analyzed for smoking status, previous radioactive iodine, thyroidectomy, number of decompressions, motility restriction, amount of strabismus, number of surgeries, surgical dose, and number of muscles involved on radiography.
Thirty patients (average age, 63.9 years; 50% male; 59% current/former smokers) were included: 12 statin users and 18 nonusers. Statin users averaged fewer decompressions (1.3 in users vs 2.4 in nonusers [P = 0.04]). Statin users on average had 15 mm of total strabismus surgery compared with 21.4 mm in the nonuser group (P = 0.09) and had fewer muscles involved radiographically (4.3 vs 5.1 [P = 0.08])
Compared to nonusers, statin users tended to have fewer decompressions, less restriction, fewer surgeries, and fewer muscles involved despite having more current smokers (36% vs 5%), more males, more RAI, and fewer thyroidectomies, all of which are associated with worse TED. In our cohort of patients with TED and strabismus, statin therapy significantly reduced the number of orbital decompressions. Oral statin therapy also trended toward reducing the number and amount of strabismus surgeries as well as radiographic indication of muscle involvement, although these did not meet statistical significance.
The interactive effects of genetic polymorphisms within LFA-1/ICAM-1/GSK-3β pathway and environmental hazards on the development of Graves’ opthalmopathy
2018, Experimental Eye Research
Citation Excerpt :
As for SNPs situated within LFA-1 and GSK-3β, it seemed that it was the first study to investigate their associations with GO risk. Among the investigated environmental hazards, smoking has been regarded as a predisposing factor for GO and its aggravation (Shine et al., 1990). Smoking also delayed the GO patients’ responses to intravenous glucocorticoids, and the incidence of GO deterioration was raised largely among ones with smoking history (Bartalena et al., 1998; Eckstein et al., 2003; Kahaly et al., 2005).
The purpose of this investigation was to explore the combined effects of single nucleotide polymorphisms (SNPs) within LFA-1/ICAM-1/GSK-3β pathway and environmental hazards on susceptibility to Graves' opthalmopathy (GO) among a Chinese Han population. Altogether 305 GO patients and 283 Graves' disease (GD) subjects were recruited. Information relevant to the participants' age, gender, body mass index (BMI), regular physical activity, smoking history, alcohol intake, stressful work environment, stress at work, family history of thyroid disease and ¹³¹I treatment were summarized, and the participants’ related SNPs of LFA-1/ICAM-1/GSK-3β were also detected. Then the gene-gene and gene-environment interactions were evaluated by logistic regression model and multi-factor dimensionality reduction (MDR) modeling. The results exhibited that age, BMI, smoking history, stressful work, stress at home, family history of thyroid disease and ¹³¹I treatment appeared as potential indicators regulating GO risk, when either univariate or multivariate regression analysis was performed (all P < 0.05). Moreover, rs12716977 (T > C) and rs2230433 (G > C) of LFA-1, rs1799969 (G > A) and rs5498 (A > G) of ICAM-1, as well as rs6438552 (T > C) and rs334558 (T > C) of GSK-3β were significantly associated with altered susceptibility to GO under the allelic models (all P < 0.05). Also haplotype TGAATC acted as a protective factor against GO risk (P < 0.05), whereas haplotype CGAACC largely elevated risk of GO (P < 0.05). Besides, logistic regression analysis demonstrated that rs12716927, rs5498 and rs6438552 all would affect the influences exerted by age, BMI, smoking history, stressful work, stress at home, family history of thyroid disease or ¹³¹I treatment on GO susceptibility (all P < 0.05). MDR modeling implied that the combined model of rs12716977, rs2230433 and rs1799969 was the supreme interactive model when BMI was co-assessed, and the interactive model of rs12716977, rs334558 and rs5491 was the most desirable among the smoking population. In conclusion, gene-gene and gene-environment interactions served as a crucial manner in affecting susceptibility to GO, providing solid evidences for screening effective GO-susceptible biomarkers and exploring potential GO treatment strategies.
Management of graves myopathy: Thyroid-associated orbitopathy: when should we operate?
2018, Journal of AAPOS
Thyroid-associated orbitopathy (TAO) is an autoimmune disorder that affects multiple periocular tissues. In TAO, an active immunologic inflammatory phase is typically followed by a cicatrizing recovery phase. Management in the inflammatory phase is supportive, and surgical rehabilitation should generally be deferred until the patient is stable. We review current treatment concepts, with a focus on the timing and sequence of surgical procedures to address proptosis, motility restriction, and eyelid malposition in patients with TAO. A stepwise surgical approach maximizes the predictability of surgical outcomes and minimizes reoperations.
Hyperthyroid Disorders
2015, Williams Textbook of Endocrinology
Smoking and strabismus surgery in patients with thyroid eye disease
2011, Ophthalmology
To investigate the relationship between smoking status at presentation and the use of strabismus surgery in the management of patients with thyroid eye disease.
Retrospective review of a noncomparative series of patients with thyroid eye disease.
All patients with thyroid eye disease under the care of a single consultant at Moorfields Eye Hospital between 1997 and 2002 (inclusive).
Retrospective review of clinical case notes.
Survival analysis of patients in cohort and the frequency of strabismus surgery in relation to smoking status at ophthalmic presentation. A subanalysis of patients who underwent orbital decompression and those that did not was undertaken.
Of 501 patients seen during the study period, 425 (85%) of 501 sets of notes were available for review, and initial smoking status was recorded for 89% (378/425) of patients, of whom approximately one half (196/378; 52%) were active smokers. Of the smokers, 51 (26%) of 196 underwent strabismus surgery, compared with only 19 (14%) of 138 nonsmokers at presentation. When adjusted for age, the hazards ratio of having strabismus surgery during management for smokers at presentation versus nonactive smokers was 2.19. In the group who did not undergo orbital decompression, this hazard ratio increased to 4.86.
Within this thyroid eye disease cohort, the proportion of smokers at presentation was much larger than that of the general population. There was an increased use of strabismus surgery in active smokers at presentation than in nonactive smokers. This finding was independent of the orbital decompression surgery. The results are consistent with those of previous reports of more severe thyroid eye disease in smokers and raise the possibility that smoking cessation early in the disease may reduce the severity of the changes and the number of rehabilitative strabismus operations needed.
The author(s) have no proprietary or commercial interest in any materials discussed in this article.

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EPIDEMIOLOGYAssociation between Graves' ophthalmopathy and smoking

Abstract

Ophthalmology

Autoimmunity in Graves' ophthalmopathy: a review

J R Soc Med

Endocrine ophthalmopathy: current ideas concerning etiology, pathogenesis and treatment

Endocniol Rev

Ultrasonographic evidence of a consistent orbital involvement in Graves' disease

N Engl J Med

Appearance of Graves' eye disease on orbital computed tomography

J Comput Assist Tomogr

Ophthalmic Graves' disease: natural history and detailed thyroid function studies

Br Med J

Genetic factors in Graves' ophthalmopathy

Clin Endocrinol

Differentiation of autoimmune ophthalmopathy from Graves' hyperthyroidism by analysis of genetic markers

Clin Endocrinol

$EPIDEMIOLOGY$
Association between Graves' ophthalmopathy and smoking