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Research Article Open access CC BY 3.0

Risk Factors for the Development of Ophthalmopathy in Patients with Hashimoto’s Thyroiditis

Ilhem El Kochairi, Bernard Champion, Jack R. Wall

Ophthalmology Research: An International Journal · pp. 177–188 · Published 12 Feb 2014

10.9734/OR/2014/4562

Abstract

Background: Ophthalmopathy, or thyroid eye disease (TED), is more often associated with Graves’ hyperthyroidism than Hashimoto’s thyroiditis. In the latter disorder, the pathogenesis of the eye signs may be different and the influence of well-known risk factors for the development of eye signs in patients with Graves’ hyperthyroidism, such as smoking, age and gender, have not been studied in patients with Hashimoto’s thyroiditis. The aim of our study was to identify the risk factors which might influence the development of ophthalmopathy in patients with Hashimoto’s thyroiditis. Methods: A retrospective cross sectional study included 105 patients with Hashimoto’s thyroiditis with and without ophthalmopathy and investigated 6 potential risk factors namely; age, gender, smoking, vitamin D deficiency, serum TSH and serum levels of antibodies to thyroid peroxidase (TPO) and thyroglobulin (Tg). A binary logistic regression test was used to determine whether one or more of the factors were predictive for i) ophthalmopathy ii) upper eyelid retraction (UER), often the only sign in patients with Hashimoto’s thyroiditis iii) the type of ophthalmopathy (congestive ophthalmopathy, ocular myopathy or both) or iv) the activity of the eye disease assessed as Clinical Activity Score (CAS), in patients with Hashimoto’s thyroiditis. Results: Our analyses showed a protective effect of ageing on the development of ophthalmopathy in patients with Hashimoto’s thyroiditis, the risk decreasing by 5.4% for each additional year and a detrimental effect of smoking, with a risk of ophthalmopathy 5.5 times greater in smokers. Increased serum TSH was not shown to be a risk factor for ophthalmopathy or its severity.  High serum levels of TPO antibodies were found to be protective against the development of UER but not ophthalmopathy. None of the tested factors seemed to influence the risk of any ophthalmopathy subtype namely, congestive ophthalmopathy, ocular myopathy or mixed disease. However, gender has an effect on the activity of ophthalmopathy, men with Hashimoto’s thyroiditis related eye disease being 18 times more likely to develop active ophthalmopathy than women. Conclusions: Because the risk of ophthalmopathy in patients with Hashimoto’s thyroiditis decreases with age, but is linked to smoking at all ages, patients with Hashimoto’s thyroiditis should be advised not to smoke as a preventive measure against development of ophthalmopathy, regardless of their age. Hashimoto’s thyroiditis-related ophthalmopathy is more active in male patients who should therefore be monitored more closely. The mechanism for the observed risk reduction of UER development in the presence of high levels of TPO antibodies could be studied to help with our understanding of the pathophysiology of ophthalmopathy and the development of new therapies.  

Hashimoto’s thyroiditis ophthalmopathy smoking vitamin D autoantibodies upper eyelid retraction

References (33)

  1. 1 Clinical criteria for the assessment of disease activity in Graves' ophthalmopathy: a novel approach. [DOI]
  2. 2 Relation between Therapy for Hyperthyroidism and the Course of Graves' Ophthalmopathy [DOI]
  3. 3 Pathogenesis of Graves' Ophthalmopathy [DOI]
  4. 4 Smoking and Risk of Graves' Disease [DOI]
  5. 5 Smoking and thyroid disorders--a meta-analysis [DOI]
  6. 6 Age and Gender Predict the Outcome of Treatment for Graves' Hyperthyroidism [DOI]
  7. 7 Age and gender influence the severity of thyroid‐associated ophthalmopathy: a study of 101 patients attending a combined thyroid‐eye clinic [DOI]
  8. 8 Influences of Age, Gender, Smoking, and Family History on Autoimmune Thyroid Disease Phenotype [DOI]
  9. 9 The Initial Clinical Characteristics of Graves' Orbitopathy Vary With Age and Sex [DOI]
  10. 10 Genetic Susceptibility to Autoimmune Thyroid Disease: Past, Present, and Future [DOI]
  11. 11 Temporal relationship between onset of Graves’ ophthalmopathy and onset of thyroidal Graves’ disease [DOI]
  12. 12 The Combination of Absent Thyroid Peroxidase Antibodies and High Thyroid-Stimulating Immunoglobulin Levels in Graves' Disease Identifies a Group at Markedly Increased Risk of Ophthalmopathy [DOI]
  13. 13 Classification of the Eye Changes of Graves' Disease [DOI]
  14. 14 Smoking as a Risk Factor for Graves' Disease, Toxic Nodular Goiter, and Autoimmune Hypothyroidism [DOI]
  15. 15 The Association of Cigarette Smoking with Clinical Subtypes of Ophthalmic Gravesʼ Disease [DOI]
  16. 16 Age-Dependent T Cell Tolerance and Autoimmunity to Myelin Basic Protein [DOI]
  17. 17 Vitamin D receptor gene polymorphisms are associated with risk of Hashimoto's thyroiditis in Chinese patients in Taiwan [DOI]
  18. 18 Effect of Smoking on Orbital Fat and Muscle Volume in Graves' Orbitopathy [DOI]
  19. 19 Eye and Eyelid Abnormalities Are Common in Patients with Hashimoto's Thyroiditis [DOI]
  20. 20 Hyperthyroid vs hypothyroid eye disease: the same severity and activity [DOI]
  21. 21 Treating the thyroid in the presence of Graves’ ophthalmopathy [DOI]
  22. 22 Smoking and autoimmune thyroid disease: the plot thickens [DOI]
  23. 23 Function of regulatory T-cells improved by dexamethasone in Graves' disease [DOI]
  24. 24 Epitopes, immunoglobulin classes and immunoglobulin G subclasses of calsequestrin antibodies in patients with thyroid eye disease [DOI]
  25. 25 Radioisotopic Thyroidolymphography in Patients with Graves' Disease1 [DOI]
  26. 26 Age‐Related Changes of Thyroid Function and Immunologic Abnormalities in Patients with Hyperthyroidism Due to Graves' Disease [DOI]
  27. 27 VARIATION IN THYROID STATUS IN PATIENTS WITH GRAVES' ORBITOPATHY [DOI]
  28. 28 Histomorphological Aspects of the Development of Thyroid Autoimmune Diseases: Consequences for Our Understanding of Endocrine Ophthalmopathy [DOI]
  29. 29 Maintenance of Immune Tolerance to a Neo-Self Acetylcholine Receptor Antigen with Aging: Implications for Late-Onset Autoimmunity [DOI]
  30. 30 Thymus function, ageing and autoimmunity [DOI]
  31. 31 Hyperthyroidism in the Elderly [DOI]
  32. 32 A Diminished Adherence of Blood Lymphocytes of Patients with Thyroid Autoimmune Disease to High Endothelial Venules in the Thyroid and the Thyroid-Draining Lymph Nodes [DOI]
  33. 33 Autoimmune Addison's disease: new players in diagnosis and treatment [DOI]

Cited by 3

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Thyroid Associated Ophthalomopathy in a Patient with Hashimoto's Thyroiditis

Ho-Jun Lee, Y. Kim, S. Kweon · 2016

Relationship between Clinical and Immunological Features of Thyroid Autoimmunity and Ophthalmopathy during Pregnancy

J. Wall, H. Lahooti, E. Hibbert · Journal of Thyroid Research · 2015

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