Novel Insight into Non-Genetic Risk Factors of Graves’ Orbitopathy

Abstract

An assessment of the risk of Graves’ orbitopathy (GO) is an important challenge in Graves’ disease (GD) management. The purpose of this study was to compare non-genetic parameters in GD patients with and without GO in order to find novel risk factors and to verify the factors already reported. A total number of 161 people, 70 with GO and 91 non-GO patients were included in this study. GO was confirmed to be associated with smoking, older age, higher TSH receptor antibodies (TRAb) and lower thyroglobulin antibody (TgAb) levels and hypercholesterolemia. We demonstrated the latter correlation even for only a mild increase in LDL cholesterol. Importantly, our study provides novel potential GO risk factors, including higher serum creatinine levels, higher MCV and lower PLT. If further confirmed, these new, simple and easily accessible potential GO markers may constitute valuable auxiliary markers in GO risk assessments. We additionally proved that in moderate to severe GO, gender-related differences attenuate. No impact of vitamin D deficiency in GO development in patients with 25-hydroxyvitamin D [25(OH)D] > 20 ng/mL was found. The present report provides a set of GO risk factors, which can be used as a precise tool for an individual GO risk assessment.

Associations between Lipid Profiles and Graves’ Orbitopathy can Be HLA-Dependent

“…The significance of TC and LDL levels in GO development is also a novel finding [ 5 , 7 , 8 , 9 ]. No such relationship was demonstrated for other lipid parameters [ 8 , 9 ].…”

“…The significance of TC and LDL levels in GO development is also a novel finding [ 5 , 7 , 8 , 9 ]. No such relationship was demonstrated for other lipid parameters [ 8 , 9 ]. Concentrations of TC and LDL were positively correlated not only with GO risk but also with a GO CAS result [ 7 , 20 ].…”

“…Therefore, a recommendation of active cholesterol-lowering therapy in patients with GD was introduced, especially in those with other high-risk factors such as smoking, high TRAb levels, or uncontrolled hyper- or hypothyroidism [ 3 , 5 ]. It should be emphasized that a recent report has demonstrated that the risk of GO is significantly increased not only in patients with high cholesterol levels but also with only a slight elevation of LDL and—which seems very important—with even high normal TC levels [ 9 ].…”

Safety of non-standard regimen of systemic steroid therapy in patients with Graves’ orbitopathy: a single-centre experience

“…Both endogenous and exogenous risk factors may affect the course and severity of GO. Among the non-modifiable factors are gender, age, race, and genetic susceptibility [ 5 , 8 , 9 ]. Although there is a predilection for the female gender, males are more prone to a severe course, especially at the age above 50 years.…”

“…Although there is a predilection for the female gender, males are more prone to a severe course, especially at the age above 50 years. The environmental factors include thyroid dysfunction, radioactive iodine (RAI) treatment, oxidative stress, and hypercholesterolemia; however, the main modifiable factor is smoking exposure (active and passive) [ 5 , 8 , 9 ]. Tobacco smokers experience more exacerbated ocular symptoms and poorer response to standard immunosuppressive therapy [ 10 , 11 ].…”