Statins and Thyroid Eye Disease: A Propensity Score-Matched Retrospective Cohort Analysis

Background Thyroid eye disease is a sight-threatening disorder associated with Graves's disease. While treatment is aimed at stabilizing established thyroid eye disease, there are limited investigations regarding prevention. Statins, known for their anti-inflammatory properties, are one such treatment that has been investigated for thyroid eye disease. This study retrospectively analyzes the impact of statin medications on thyroid eye disease and related outcomes from real-world data using TriNetX Global Collaborative Network (TriNetX, Cambridge, MA, USA). Objective The primary objective of this study is to analyze the risk of developing thyroid eye disease in patients with Graves' disease treated with statin medications relative to those without exposure up to five years. Secondary objectives of this study include analyzing thyroid eye disease-related outcomes, including diplopia, optic nerve surgery, optic nerve injury, strabismus, blindness, requirement for teprotumumab, color vision deficiencies, and referral to ophthalmology. Methods Data were collated utilizing TriNetX Global Collaborative Network, a platform of globally de-identified patient information from over 140 healthcare organizations. Patients more than 18 years of age with a diagnosis of Graves' disease (ICD-10: E05.0 Thyrotoxicosis with Diffuse Goiter) were divided into Cohorts A (administration of statin medication following diagnosis of Graves' disease, n = 66,444) and B (no statin medication administration, n = 225,905). Via implementation of propensity score matching to control for confounding factors, a total of n = 43,025 matched patients per cohort was obtained. Hazard ratios (HRs) and 95% confidence intervals (CIs) were used to assess the primary and secondary objectives over a five-year follow-up period. The t-test was used for the calculation of mean averages of ophthalmology referrals and to determine statistical significance. Results Patients treated with statin medications (Cohort A) demonstrated a significantly lower HR for the development of exophthalmos (HR = 0.559, 95% CI 0.521-0.601, p < 0.001). Statin medications were furthermore associated with a reduced HR for diplopia (p < 0.001), optic nerve surgery (p = 0.018), and requirement for teprotumumab (p = 0.047). No significant reduction in hazards for color vision deficits, strabismus, optic nerve injury, or blindness was noted. Additionally, there was no significant difference in referrals to ophthalmology. Conclusion The findings from this study suggest that statin therapy may be protective against the development of thyroid eye disease and associated complications. Further randomized controlled trials are required to validate these findings and establish a therapeutic role for statins in thyroid eye disease.