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Risk factors for graves' orbitopathy: A systematic review and meta-analysis
Lidia Cheidde1, Dillan Cunha Amaral2,3, Yuri Aleksander-Ivanov4
1Faculty of Medicine, Pontifical Catholic University of São Paulo, 290 Rua Joubert Wey, Vila Boa Vista, Sorocaba, SP, 18030-070, Brazil.
European Journal of Ophthalmology
|July 24, 2026
Summary
Smoking significantly increases the risk of Graves
Area of Science:
- Endocrinology
- Ophthalmology
- Genetics
Background:
- Graves' orbitopathy (GO) is an autoimmune condition affecting the eyes.
- Understanding modifiable risk factors is key for GO prevention.
Purpose of the Study:
- To comprehensively analyze clinical and biomarker risk factors for Graves' orbitopathy.
- To guide the development of targeted prevention strategies for GO.
Main Methods:
- Systematic literature search of PubMed, Embase, and Web of Science databases.
- Inclusion of 22 studies comparing GO patients with Graves' disease patients without GO or healthy controls.
- Statistical analysis using Review Manager 5.4.1.
Main Results:
- Current and former smoking significantly increased GO risk (ORs 2.00 and 1.77, respectively) compared to GD without GO.
- Thyroidectomy showed a protective effect against GO (OR 2.53).
- Elevated FT4 and decreased TSH levels were associated with GO when compared to healthy controls.
Conclusions:
- Smoking is a major modifiable risk factor for Graves' orbitopathy.
- Thyroidectomy may offer a protective effect.
- Specific thyroid hormone levels (FT4, TSH) are associated with GO.
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