ATA Study Details Risk Factors, Comorbidities Associated with Severe Thyroid Eye Disease

Kimberly Cockerham, MD

A new analysis presented at the 90th Annual Meeting of the American Thyroid Association (ATA) is providing clinicians with an overview of comorbidities most commonly associated with increased disease severity among patients with thyroid eye disease (TED).

An analysis of data from nearly 700 patients with varying levels of disease severity across the US, results indicate thyroid status, tobacco use, TED duration, TED activity, and the number of comorbidities could influence TED severity, but also suggest male gender and patient age did not appear to influence disease severity.

“As disease-modifying therapies for thyroid eye disease (TED) continue to emerge, better understanding of TED patients’ comorbidities is required, particularly in severe TED where quality of life, also known as QOL, is greatly impacted,” said Kimberly Cockerham, MD, an adjunct clinical associate professor in the Department of Ophthalmology air the Stanford School of Medicine, during her presentation at ATA 2021.

Funded by Horizon Therapeutics, which produces teprotumumab-trbw (Tepezza), the retrospective study was designed to leverage data related to TED patients provided by US endocrinologists and ophthalmologists who regularly treat TED. These providers were asked to randomly select 4 or more patients for inclusion in the study. Investigators obtained demographic information, medical history, and TED characteristics from medical records using a standardized data collection tool.

In total, 170 physicians provided data related to 667 adult patients. This cohort had a mean age of 49±13.6 years, 75% were women, 66.7% were Caucasian, and the mean TED duration was 3.2±2.9 years. Of the 667 included in the study, 15% had active TED, which was defined as a clinical activity score of 3 or greater, and 13% had severe TED. The mean number of non-thyroidal comorbidities was 1.5±1.2, with 44% reporting the presence of at least 2 non-thyroidal comorbidities. The most common non-thyroidal comorbidities were hypertension (37%), anxiety (34%), depression (20%), type 2 diabetes (18%), and non-thyroidal autoimmune diseases (14%).

Upon analysis, results indicated severe TED patients had a significantly greater number of non-thyroidal comorbidities than mild patients (1.8±1.3 vs 1.3±1.2; P <.001) despite similar age, sex distribution, and ethnicity. Investigators highlighted patients with TED were more likely to have non-thyroidal autoimmune disease (22% vs 11%), hyperglycemia (15% vs 6%), skin complications (6% vs 1%), and liver disease or complications (5% vs 1%) (P for all <.023).

Additionally, patients with severe TED were euthyroid (69% vs 82%; p=.007) and had 0 non-thyroidal comorbidities (14% vs 27%; P=.015) less often than their counterparts with mild TED. Investigators also pointed out patients with inactive TED, which was defined as a CAS score of 0 or 1, had lower rates of hypertension than their counterparts with severe TED (34% vs 50%; P=.004).

In her presentation, Cockerham noted the need for further research to confirm findings.

“Further data are needed to better understand and confirm our findings, which may have important implications for severe thyroid eye disease risk factors and overall patient management,” Cockerham added.

This study, “Comorbidities and Thyroid Eye Disease Severity: Which Factors are Most Commonly Associated with More Severe Disease?,” was presented at ATA 2021.