Analysis Of Risk Factors Of Thyroid-associated Ophthalmopathy In The Progression Of Graves’ Disease

Objective:Graves disease（GD）is an autoimmune disease characterized by diffuse goiter and hyperthyroidism.About 25%～50%of GD patients can develop Graves ophthalmopathy（GO）.Most of the GD patients in the treatment were ignored because of the slight initial ocular symptoms,which to some extent delayed the diagnosis and treatment of GO.Since more GD can be developed into GO,it is very important to understand the related factors and the relationship between them.This subject observes the correlation between the levels of endocrine hormones in GD patients and their related changes,smoking history and GO,so as to find the relevant influencing factors that lead to the onset of GO,and lay the theoretical foundation for the early diagnosis of GO.Methods:The clinical data of the new patients with GD（60 cases）admitted to the Tianjin Medical University General Hospital from June 2018 to October 2019 were collected.The basic information,eye condition and thyroid function indicators of patients were recorded.The patients were followed up for 7 months,and their thyroid function was reexamined and recorded every month.According to the changes of the patients’eye conditions,they were divided into two groups:no GO group（36 cases）and mild GO group（24 cases）.The data of each group were analyzed repeated measurement data of ANOVA or Mann-Whitney U test.Spearman rank correlation and ROC curve were used to analyze the correlation and judge the diagnostic value.Finally,multiple variables were included for logistic regression analysis.Results:1.There were 24 cases（66.7%）of hypothyroidism and 12（33.3%）of normal thyroid function in no GO group.And in mild GO group,there were 20 cases（83.3%）of hypothyroidism and 4（16.7%）of normal thyroid function.2.Conjunctival hyperemia occurred in 2 cases（5.6%）and eyelid swelling in 4（11.1%）in the no GO group,without eyelid signs,exophthalmos,diplopia or corneal exposure.In the mild GO group,there were 4 cases（16.7%）of upper eyelid lag,23（95.8%）of eyelid retraction,7（29.2%）of conjunctival hyperemia,10（41.7%）of eyelid swelling and 5 of exophthalmos（20.8%）,without diplopia or corneal exposure.3.FT₃ and FT₄ levels（P=0.015、P=0.037）of no GO group and mild GO group were statistically significant,while there was no significant difference in TSH level（P=0.112）.Also its level in mild GO group were higher than those in no GO group.4.Compared with the no GO group and the mild GO group,the difference between the baseline value,difference value of FT₃（P=0.027、P=0.037）and TRAb titer level at the time of GD diagnosis（P=0.004）was statistically significant.5.The baseline and difference value of FT₃（AUC=0.672,P=0.025;AUC=0.685,P=0.016）,and the level of TRAb titer（AUC=0.719,P=0.004）have certain diagnostic significance for the occurrence of GO,but the diagnostic value of FT₃ is general,and the diagnostic value of TRAb is better.6.Multivariate logistic regression analysis showed that smoking was independently associated with the occurrence of thyroid-related eye diseases（OR=4.796,95%CI=1.120～20.529,P=0.035）.Conclusions:1.TRAb titer level and FT₃level fluctuation during the diagnosis and treatment of GD have certain significance for the early diagnosis of GO,but they may interact with other risk factors,and the specific mechanism needs further study.2.There are differences in thyroid function between GD patients alone and GO patients.Patients with GO have significantly higher levels of FT₃ and FT₄ than those without eye disease.3.The TRAb titer of GD patients alone was significantly different from that of GO patients who were diagnosed with GD.The level of TRAb titers in GO patients was significantly higher than those without eye disease.4.Smoking is an independent risk factor of GO,and its relative risk is 4.8 times that of non-smoking.