Abstract
ObjectiveThyroid eye disease (TED) is a debilitating autoimmune disease characterized by ocular and periorbital tissue inflammation, proptosis, and visual impairment. The known risk factors for TED include radioactive iodine therapy, female sex, and smoking. The risk factors for severe TED include hyperthyroidism, male sex, smoking, and diabetes; however, little is known about how diabetes mellitus (DM) influences TED. This claims-based analysis examined TED characteristics in patients with and without diabetes. MethodsSymphony database (2010-2015 U.S. claims) was mined for patients with ≥1 Graves’ disease diagnosis code and ≥1 TED-associated eye code, including proptosis, strabismus, diplopia, lid retraction, exposure keratoconjunctivitis, and optic neuropathy (ON). DM status was determined based on type 1 or type 2 diabetes coding. Sight-threatening TED was defined as ≥1 ON or exposure keratoconjunctivitis code. ResultsA total of 51 220 patients were identified. Of them, 2618 (5.1%) and 12 846 (25.1%) had type 1 and type 2 DM, respectively. Patients with and without DM had similar characteristics, but patients with DM were more often men (type 1: 30.3%, type 2: 28.7% vs no DM: 20.5%; both P < .001) and older at the first TED code. In patients with DM, strabismus (25.4%, 22.6% vs 19.9%) and diplopia (38.6%, 37.9% vs 29.9%) occurred more often but proptosis occurred less often (42.3%, 46.3% vs 58.5%; all P < .001). Sight-threatening TED occurred more often in patients with DM because of higher ON rates. ConclusionPatients with TED and DM may have more extraocular muscle involvement. Furthermore, the higher prevalence of severe TED stemmed from higher ON rates, possibly associated with diabetes-related vasculopathies. These hypothesis-generating data warrant further exploration.
Highlights
Thyroid eye disease (TED) is a debilitating autoimmune condition most often associated with Graves’ disease.[1]
The groups had similar patient characteristics, but on average, patients with diabetes mellitus (DM) were older at the first TED diagnosis code (Table 1) and more often men (30.3%, 28.7% vs 20.5%; both P < .001)
All TED signs and symptoms identified in patients with and without DM are described in Table 1 and Figure 2
Summary
Thyroid eye disease (TED) is a debilitating autoimmune condition most often associated with Graves’ disease.[1] In its initial, active, progressive phase, TED is characterized by ocular surface inflammation, periorbital tissue inflammation, and retro-orbital fat and muscle expansion. Retraction, proptosis, eyelid swelling, conjunctival redness and swelling, strabismus, and/or diplopia. Patients may experience some improvement, but residual clinical symptoms often persist.[2] TED can be classified as mild, moderate, severe, or sight-threatening depending on the severity of lid retraction, soft tissue involvement, proptosis, diplopia, corneal exposure, and optic nerve status.[3,4] Sight-threatening TED, which requires urgent intervention, occurs when a patient develops compressive optic neuropathy (ON) and/or corneal breakdown
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