In Brief | Thryoid Review 2025 | Opthalmology
Beyond Autoimmunity: Modifiable Risk Factors in Thyroid Eye Disease
Time to read: 04:05
Time to listen: 07:33
Originally Published: 3 February 2025
Publication: European Thyroid Journal
Type of article: In Brief
MedED Catalogue Reference: MMERD005
Category: Metabolic & Endocrine Disorders
Cross Reference: Ophthalmology
Keywords: thryoid eye disease, TED, cholesterol, modifiable disease factors
Elevated LDL and total cholesterol levels, as well as active smoking, are significantly associated with increased TED activity and severity.
This article is a review of a recent study published in The European Thyroid Journal on 3 February 2025, and reproduced here under Creative Commons Attribution 4.0 International Licence. It is not intended to represent original research, nor is it intended to replace the original research. Access the full Disclaimer Information.
Listen to Full Article
Thyroid eye disease (TED) is an autoimmune inflammatory disorder affecting the orbital tissues, occurring in approximately 30–40% of individuals with Graves’ disease (GD). Risk factors for TED include thyroid dysfunction, smoking, radioiodine therapy, male sex, advanced age, and certain genetic and demographic factors.1
Understanding and characterising the population affected by TED remains a key challenge.
However, as the management of TED is guided by disease activity and severity, this understanding is essential for identifying targeted treatment strategies, particularly for subgroups with significant inflammatory activity. Furthermore, recognising potential risk factors within different demographic contexts can help guide future research efforts.
Recent evidence has suggested a link between elevated total and low-density lipoprotein (LDL) cholesterol levels and TED. The researchers of this study set out to investigate this association.
Study Methodology
The study cohort was obtained from two tertiary hospitals in Brazil. The researchers conducted a retrospective analysis of clinical and laboratory data from patients who received treatment for GD.
Data were extracted from medical records at two tertiary centres spanning the years 1999–2021.
Patients included in the study were those who maintained a euthyroid state during clinical and laboratory evaluations and had been treated for GD with methimazole.
Study Findings
Researchers found that both high low-density lipoprotein (LDL) cholesterol and smoking were significantly associated with more active and severe forms of TED.
Logistic regression analysis showed that higher LDL and total cholesterol levels were independently correlated with increased Clinical Activity Score (CAS), with LDL cholesterol showing an odds ratio (OR) of 1.012 (95% CI: 1.003–1.021, P < 0.01) and total cholesterol, an OR of 1.010 (95% CI: 1.002–1.018, P < 0.01).
These lipid elevations also aligned with more severe disease as defined by the EUGOGO classification.
Multiple regression confirmed that TED activity was significantly associated with LDL cholesterol (P < 0.01) and smoking status (P < 0.01).
Disease Severity was further linked to lower high-density lipoprotein (HDL) cholesterol (P < 0.05, OR: 0.973,), higher LDL cholesterol (P < 0.005, OR: 1.013), and active smoking (P < 0.05, OR: 2.881).
These findings suggest that cardiovascular risk factors—especially dyslipidaemia and smoking—not only increase the risk of developing TED but may also worsen its clinical course. As such, addressing these modifiable risk factors could become an important adjunct in the management and prevention of TED progression.
Conclusion
This study reinforces the association between elevated LDL cholesterol levels and both the activity and severity of thyroid eye disease (TED).
They suggest that cardiovascular risk factors—especially dyslipidaemia and smoking—not only increase the risk of developing TED but may also worsen its clinical course. As such, addressing these modifiable risk factors could become an important adjunct in the management and prevention of TED progression.
The observed interplay between lipid levels, oxidative stress, and inflammation highlights the importance of exploring novel therapeutic strategies. In particular, the potential anti-inflammatory benefits of statins warrant further investigation as an adjunctive treatment option in TED. However, additional prospective studies are needed to confirm these associations and to evaluate the clinical efficacy of statin therapy in this context.
This article is one of a 5-part CPD series
To complete your CPD points, you should read all five articles and complete the associated CPD questionnaires. Remember you need to be Registered and logged-on to access the Questionnaire.
Original Study
Cardo, C., Bernardo Santos, R., Pinotti Pedro Miklos, A. B., Barbosa Jaconis, S., Romaldini, J. H., & Villagelin, D. (2025). The relationship between cholesterol levels and thyroid eye disease. European thyroid journal, 14(1), e240133. https://doi.org/10.1530/ETJ-24-0133
References
Disclaimer
This article is compiled from several resources researched and compiled by the contributor. It is in no way presented as an original work. Every effort has been made to attribute quotes and content correctly. Where possible all information has been independently verified. The Medical Education Network bears no responsibility for any inaccuracies which may occur from the use of third-party sources. If you have any queries regarding this article contact us
Fact-checking Policy
The Medical Education Network makes every effort to review and fact-check the articles used as source material in our summaries and original material. We have strict guidelines in relation to the publications we use as our source data, favouring peer-reviewed research wherever possible. Every effort is made to ensure that the information contained here is an accurate reflection of the original material. Should you find inaccuracies, out of date content or have any additional issues with our articles, please make use of the contact us form to notify us.
