BACKGROUND
Thyroid eye disease (TED), also known as Graves’ orbitopathy, develops in around 25% of patients with Graves’ disease. It is caused by inflammation in the eye muscles and can result in significant problems with vision that can be hard to treat. Because of this, strategies to prevent TED are required. Currently, these are limited to recommending stopping smoking, considering selenium supplementation, and considering surgery to remove the thyroid to reduce the level of antibodies that cause Graves’ disease.

Statin drugs are very effective drugs aimed at lowering cholesterol levels. They also appear to have other beneficial effects in areas unrelated to lowering cholesterol levels. Recently, statin use has been associated with lower rates of TED in patients with Graves’ disease. The researchers of this study used a large patient database to determine the relationship between stating use and TED.

THE FULL ARTICLE TITLE
Chou YT et al. Statin use and the risk of Graves’ orbitopathy: a nationwide population-based cohort study. Thyroid 2025;35(2):199-207; doi: 10.1089/ thy.2024.0536. PMID: 39804287.

SUMMARY OF THE STUDY
The researchers examined the national health insurance database in Taiwan to perform a study of individuals >40 years of age with Graves’ disease newly diagnosed between 2010 and 2019. Patients were separated by current statin use at time of the diagnosis of Graves’ disease. Patients were followed until one of the study end points was reached: TED diagnosis, switching to a different statin, statin discontinuation for more than 3 months, initiation of any cholesterol-lowering drug in patients not on statins or the end of the study period.

Statin potency and dose were recorded. Other associated factors identified included smoking status, radioactive iodine treatment for Graves’ disease, heart disease risk, and obesity. All study information relied on coding in health databases.

There were 102,858 new diagnoses of Graves’ disease included in the study. These patients were followed for 4 to 5 years after diagnosis. Some 7073 patients (6.9%) were using statins at the time of Graves’ disease diagnosis. Overall, the rate of TED development was 5 cases per 1000 person-years in statin users and 6.75 per 1000 person-years in statin nonusers. The adjusted rate of TED development after statistical analysis was 4.91 cases per 1000 person-years in statin users and 5.15 per 1000 person-years in nonusers. In subgroup analysis, statin use was associated with lower TED incidence in females and in younger patients (ages 40–60 years). No difference in effect was seen by the type of statin or by statin dose.

WHAT ARE THE IMPLICATIONS OF THIS STUDY?
In this registry-based study of patients with mostly Asian ethnicity, continued statin use at the time of Graves’ disease diagnosis was associated with lower rates of subsequent development of TED. However, the absolute effect size was small and was significant only in women in the subgroup analysis. The effect appears independent of type or potency of statin and may be more pronounced in younger individuals (ages 40–60 years). More studies are needed to clarify this effect before any recommendations if statin use in patients with Graves’ disease without another indication for stating use. However, these results are promising for patients with Graves’ disease.

— Alan Farwell, MD

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