Risk Factors for Graves' Orbitopathy; the Australian Thyroid-Associated Orbitopathy Research (ATOR) Study
Jwu Jin Khong1, Sue Finch1, Chamika De Silva1
1NorthWest Academic Centre (J.J.K., C.D.S.), The University of Melbourne, St Albans, 3021, Victoria, Australia; Department of Ophthalmology (J.J.K.), Department of Surgery, The University of Melbourne, Heidelberg, 3081 Victoria, Australia; Orbital, Plastics and Lacrimal Unit (J.J.K.), The Royal Victorian Eye and Ear Hospital, East Melbourne, 3002 Victoria, Australia; School of Mathematics and Statistics (S.F.), University of Melbourne, Parkville, 3052 Victoria, Australia; Department of Ophthalmology (S.R., J.E.C.), Flinders University of South Australia, Flinders Medical Centre, Bedford Park, 5042 South Australia, Australia; South Australian Institute of Ophthalmology (D.S.), University of Adelaide, Adelaide, 5000 South Australia, Australia; and Department of Medicine (P.R.E.), School of Clinical Sciences, Monash University, Clayton, 3168 Victoria, Australia.
Context:
Previous association studies suggest the development of Graves' orbitopathy (GO) is variably influenced by environmental risk factors.
Objective:
To determine the risk factors and predict odds for developing GO in Graves' hyperthyroidism (GH).
Design:
Case-control study.
Setting:
Multi-centre Australian Thyroid-associated Orbitopathy Research group consisting of tertiary endocrinology and ophthalmology outpatients and related private practices.
Patients Or Other Participants:
A total of 1042 participants with GH were designated as cases if they had GO (n = 604) and controls if they did not have GO (n = 438).
Main Outcome Measures:
Primary outcome was GO risk factors and secondary outcome was dysthyroid optic neuropathy (DON) with the effects of risk factors measured by odds ratio (OR) using multiple logistic regression, adjusted for known risk factors and exploratory variables.
Results:
The odds of GO increased by 17% for each decade increase in the age of onset of GH (OR 1.17, confidence interval (CI): 1.06-1.29; P = .002) and by 7% for each year increase in the duration of GH (OR 1.07, CI: 1.05-1.10; P < .001). Smoking increased the odds for GO by 2.22 for current smoker and 2.07 for exsmoker (P < .001), compared with never smoking. The odds of GO are 86% less in Graves' patients using antithyroid medication than those not (OR 0.14, CI: 0.06-0.34; P < .001). Predictors for DON were older age, oculomotility restriction, strabismus, reduced palpebral aperture, and active GO.
Conclusions:
This study identified increase age of onset, duration of GH, and smoking as risk factors for GO. Usage of antithyroid medication was negatively related to GO. Older patients with restricted ocular motility, strabismus, and active GO are at higher risk of DON and may benefit from early medical intervention.
More Related Videos
Related Concept Videos
01:25Hyperthyroidism I: Introduction
01:27Hyperthyroidism II: Pathophysiology
01:28Graves' Disease I: Introduction
01:24Graves Disease II: Pathophysiology
01:27Goiter
01:23Hypothyroidism II: Pathophysiology