Clinical Thyroidology® for the Public
Summaries for the Public from recent articles in Clinical Thyroidology
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GRAVES’ DISEASE
Statin use associated with lower incidence of developing thyroid eye disease in patients newly-diagnosed Graves’ disease
BACKGROUND
Thyroid eye disease (TED) is a complex disease that causes inflammation of the eyes, eye muscles and the surrounding tissues. TED is most often seen in patients with Graves’ disease but also can be seen with Hashimoto’s thyroiditis. It is thought to be due to thyrotropin (TSH) receptor antibodies attacking the cells known as fibroblasts in the eye muscles, resulting in inflammation and eye muscle enlargement. The cholesterol medications know as statins are thought to potentially have anti-inflammatory effects. In 1 study, statins were associated with a reduced risk of developing TED. To further investigate this association, this study examined the association between the use of statins and other cholesterol-lowering agents on the development of TED in patients with newly diagnosed Graves’ disease.
THE FULL ARTICLE TITLE
Nilsson A et al 2021 Statins decrease the risk of orbitopathy in newly diagnosed patients with Graves disease. J Clin Endocrinol Metab 106:1325–1332
SUMMARY OF THE STUDY
This was an analysis of a Swedish national drug and hospital visit database over the period 2005–2018. The analysis included adults with at least one hospital visit for newly diagnosed Graves’ disease. Individuals were followed from the time of Graves’ disease diagnosis until their first visit for TED, or until the end of 2018. A “statin user” was defined as an individual who obtained at least two prescriptions for a statin drug, starting 3 months prior to the diagnosis of Graves’ disease.
The incidence of TED was then compared between statin users and statin nonusers. Additional, separate analyses were conducted to compare the use of statins against that of other lipid-lowering agents and to compare the effects of different statins.
A total of 5574 statin users and 34,409 nonusers with Graves’ disease were analyzed. Statin users were found to be older, male, and more likely to be treated with radioactive iodine for their Graves’ disease than were nonusers; statin users were also more likely to be using other cholesterol-lowering agents. The most common statin used was simvastatin (77.1%), followed by atorvastatin (28.9%). Overall, statin use decreased the risk of developing TED by 26%. The effect was predominantly in men, with a decreased risk of 22% for men and 9% for women. Statin use for >1 year decreased the risk of developing TED by 38%, which use <1 year reduced the risk by 23%. Analysis for other lipid-lowering agents or for the combination of statins and other lipid-lowering agents revealed no decreased risk.
WHAT ARE THE IMPLICATIONS OF THIS STUDY?
The study suggests that in Swedish adults with a new diagnosis of Graves’ disease, statin therapy (mostly atorvastatin and simvastatin) was associated with a small, but significant risk reduction in the development of TED, especially in men.
— Alan P. Farwell, MD
ATA THYROID BROCHURE LINKS
Graves’ Eye Disease: https://www.thyroid.org/graves-eye-disease/
Graves’ Disease: https://www.thyroid.org/graves-disease/
ABBREVIATIONS & DEFINITIONS
Thyroid eye disease (TED): also known as Graves ophthalmopathy. TED is most often seen in patients with Graves’ disease but also can be seen with Hashimoto’s thyroiditis. TED includes inflammation of the eyes, eye muscles and the surrounding tissues.
Graves’ disease: the most common cause of hyperthyroidism in the United States. It is caused by antibodies that attack the thyroid and turn it on.
Cholesterol: the general term used to describe certain fat molecules in the blood. Examples of blood lipids include cholesterol, HDL (“good) cholesterol, LDL (“bad”) cholesterol and triglycerides.
Statins: a group of cholesterol-lowering drugs known as HMG-CoA reductase inhibitors.
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