Abstract
PurposeTo investigate the association between hypothyroidism and glaucomatous disease.MethodsThis cross-sectional study included all subjects above the age of 40 years from two nationwide surveys: the 2008 National Health Interview Survey (NHIS) as well as the 2007 and 2008 National Health and Nutrition Examination Survey (NHANES). The presence or absence of glaucoma, thyroid disease and other demographic and health-related information including comorbidities was ascertained via interview. Blood samples were collected from NHANES subjects and analyzed for thyrotropin (TSH).ResultsA total of 13,599 and 3,839 NHIS and NHANES participants respectively were analyzed to assess for a possible relationship between self-reported glaucoma, and self-reported hypothyroidism as well as self-reported thyroid disease. The unadjusted odds ratio (OR) for NHIS showed a significant association between self-reported glaucoma and self-reported hypothyroidism (OR 1.46, 95% confidence interval [CI] 1.07-1.99). Multivariate logistic regression analysis adjusted for age, gender, race, comorbidities, and health-related behavior, however, showed no association between self-reported glaucoma and hypothyroidism or thyroid disease in both surveys (OR 1.60, 95%CI 0.87-2.95 for NHIS; OR 1.05, 95%CI 0.59-1.88 for NHANES).ConclusionA previously reported association between hypothyroidism and glaucomatous disease was not confirmed in two large U.S. health survey populations. While such an association was noted in the univariate analysis for the NHIS survey, such a relationship was not found in the multivariate analysis after adjustment for potential confounding variables.
Highlights
There have been conflicting reports regarding whether or not hypothyroidism is independently associated with the incidence or prevalence of open angle glaucoma (OAG)
A total of 13,599 and 3,839 National Health Interview Survey (NHIS) and National Health and Nutrition Examination Survey (NHANES) participants respectively were analyzed to assess for a possible relationship between self-reported glaucoma, and self-reported hypothyroidism as well as self-reported thyroid disease
Multivariate logistic regression analysis adjusted for age, gender, race, comorbidities, and health-related behavior, showed no association between self-reported glaucoma and hypothyroidism or thyroid disease in both surveys
Summary
There have been conflicting reports regarding whether or not hypothyroidism is independently associated with the incidence or prevalence of open angle glaucoma (OAG). Since Hertel’s initial report of two hypothyroidism patients whose intraocular pressure (IOP) was lower after thyroid hormone replacement therapy [1], there have been supportive cases and case series presented by several other groups.[2,3,4,5,6,7,8] In contrast, several other reports have shown no association between hypothyroidism and OAG.[9,10,11] The underlying hypothesis for why hypothyroidism may be an independent risk factor for OAG is based upon the belief that the low metabolic condition caused by this condition results in reduced enzymatic activity that adversely impacts aqueous humor dynamics. At least five population-based studies have been analyzed for a possible association between thyroid abnormalities and glaucoma.[12,13,14,15,16] Two such studies reported a positive association between hypothyroidism and the likelihood of having OAG [12,15] and others showed an association between thyroid disease and glaucoma.[14,16] One study, showed no association between hypothyroidism and OAG.[13]
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