ETA2023 Poster Presentations Thyroid Eye Disease (9 abstracts)
Incidence and risk factors for graves’ orbitopathy in patients who underwent anti-inframmatory and immunosuppressive treatment during medical treatment for graves’ disease
Natsuko Watanabe 1 , Jaeduk Noh 1 , Ai Kozaki 2 , Nami Suzuki 1 , Ai Yoshihara 1 , Masako Matsumoto 1 , Miho Fukushita 1 , Hideyuki Imal 1 , Shigenori Hiruma 1 , Tosyu Inoue 2 , Kiminori Sugino 3 & Koichi Ito 4
1Ito Hospital, Internal Medicine, Tokyo, Japan; 2Olympia Eye Hospital, Japan; 3Ito Hospital, Surgery, Tokyo, Japan; 4Ito Hospital, Ito Hospital, Surgery, Tokyo, Japan
Objective: Appropriate administration of anti-inflammatory and immunosuppressive treatment (AIIST) is still important for patients with Graves’ orbitopathy (GO). This study aimed to clarify the incidence of and risk factors for GO treated with AIIST, among newly diagnosed Graves’ disease (GD) patients in Japan.
Methods: A total of 1558 GD patients who were newly diagnosed at Ito Hospital during the year 2011 were investigated. AIIST included local administration and/or systemic glucocorticoid and retrobulbar irradiation. Local glucocorticoid administration included eyelid and/or sub-Tenon’s injection. Using a multivariable Cox proportional hazards model, risk factors for GO that underwent AIIST during medical treatment, including at the diagnosis, of GD, were investigated. Baseline variables at the time of GD diagnosis [age, sex, smoking habit, FT3, FT4, TSH, TSH binding inhibitory immunoglobulin (TBII), thyroglobulin antibody (TgAb), thyroid peroxidase antibody (TPOAb), total cholesterol, white blood cells, neutrophils, lymphocytes, and the neutrophil to lymphocyte ratio] were analyzed.
Results: AIIST was administered to 97 patients (6.2%). The median interval between the first visit and AIIST was 5 (range 0.1-44) months. The severity of GO that underwent AIIST was mild in 29 patients (1.9%, 29/1558) and moderate to severe in 67 patients (4.3%, 67/1558), and most severe (sight-threatening) in only one case (0.1%, 1/1558). For AIIST, 93 subjects were administered glucocorticoids, and 19 patients received irradiation therapy. Of these patients, 39 received as combination therapy, and 58 patients received as monotherapy. Of the 72 patients who underwent eyelid injection, 29 were given as monotherapy despite moderate to severe GO. The reason for this was moderate to severe findings only in the eyelids (n =7) or moderate to severe proptosis, but with only active manifestations in the eyelids to be treated (n =22). The risk factors and associated hazard ratios for GO that underwent AIIST were: age (per 10 years) 1.23 (95% confidence interval: 1.07-1.42), P = 0.004; TSH binding inhibitory immunoglobulin (TBII) (per 10 IU/l) 1.35 (1.16-1.57), P = 0.0001; and thyroglobulin antibody (TgAb) negativity 2.98 (1.91-4.64), P < 0.0001.
Conclusions: AIIST was performed in patients with active manifestations of GO, accounting for 6.2% of newly diagnosed GD patients. The risk factors for GO that underwent AIIST were higher age, higher TBII, and TgAb negativity.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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