Hyperthyroid patients without Graves' orbitopathy are not at increased risk of developing glaucoma: a nationwide Danish
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ORIGINAL ARTICLE
Hyperthyroid patients without Graves' orbitopathy are not at increased risk of developing glaucoma: a nationwide Danish register-based case-control study F. Brandt1,2 M. Thvilum2 L. Hegedüs2 T. H. Brix2 ●
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Received: 5 August 2017 / Accepted: 24 November 2017 / Published online: 2 December 2017 © Springer Science+Business Media, LLC, part of Springer Nature 2017
Abstract Purpose Graves' disease (GD) and toxic nodular goiter (TNG) are associated with various comorbidities. However, it is unclarified whether TNG and GD without orbitopathy are associated with glaucoma. Methods This was a case-control study using recordlinkage data from nationwide Danish health registers. 28,461 patients with GD and 17,283 with TNG were included. Each case was age and sex matched with four non-hyperthyroid controls and followed over a mean period of 8 years. Data on glaucoma was obtained by record linkage within the National Danish Patient Register and/or the Danish National Prescription Registry. Logistic and Cox regression models were used to assess the risk of glaucoma before and after the diagnosis of GD and TNG. Results Compared to controls, there was a significantly increased frequency of glaucoma in patients with GD (4.6 vs. 4.2%, P = 0.006) and in patients with TNG (6.2 vs. 5.7%, P = 0.003). Prior to the diagnosis of hyperthyroidism, the odds ratio (OR) for glaucoma was non-significant in GD (1.09, 95% CI: 1.00–1.18) but slightly increased in TNG (1.13, 95% CI: 1.02–1.24). However, in TNG the OR attenuated completely when only including patients without co-morbidity in the analysis (1.03, 95% CI: 0.93–1.14). After adjustment for pre-existing co-morbidity, the hazard ratio (HR) for glaucoma following GD and TNG was not
significantly increased (HR 1.08, 95% CI: 0.98–1.18 and HR 1.10, 95% CI: 0.99–1.21, respectively). Conclusions Neither prior to nor following the diagnosis of GD and TNG had any significant association with glaucoma. Keywords Graves' disease Toxic nodular goiter Glaucoma Register study ●
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Abbreviations GD Graves' disease TNG Toxic nodular goiter GO Graves' orbitopathy CI Confidence interval OR Odds ratio HR Hazard ratio CS Charlson score DCRS The Danish Civil Registration System DDB The Danish Demographic Database DNPR The Danish National Patient Registry DNPrR The Danish National Prescription Registry
Introduction * F. Brandt [email protected] 1
Department of Internal Medicine, Hospital of Southern Jutland, Sydvang 1, 6400 Sønderborg, Denmark
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Department of Endocrinology and Metabolism, Odense University Hospital, Kløvervænget 6, 5000 Odense, Denmark
Graves' disease (GD) is not only the most common cause of hyperthyroidism [1], but it is also complicated by Graves’ orbitopathy (GO) in a significant number of patients [2, 3]. Due to anatomical changes within the orbit, such as hypertrophy of the extraocular eye muscles and the proliferation of retrobulbar fat and connective tissue, these patients have a propensity for developing increased intraocular pressure.
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