Abstract
Purpose :
The purpose of this study is to investigate the association between cannabis usage and thyroid eye disease (TED) in autoimmune hyperthyroidism patients. While there is a well-established link between cigarette smoking and thyroid eye disease, there is a paucity of research on the effect of cannabis usage on TED incidence and severity.
Methods :
This cohort study examined data from the TriNetX Research Network, a de-identified electronic health record platform, for patients with autoimmune hyperthyroidism between December 1, 2003 to December 1, 2023. The primary outcome was TED presentation and treatment in cannabis users versus non-users, excluding patients with nicotine usage. The secondary outcome was TED presentation and treatments in nicotine users versus non-users, excluding patients with cannabis usage. TED presentation included exophthalmos, eyelid retraction, eyelid edema, orbital edema, strabismus, and optic neuritis. TED treatment included teprotumumab, methylprednisolone, and tarsorrhaphy. Propensity matching was performed to control for age at diagnosis of autoimmune hyperthyroidism, sex, race, diabetes mellitus type 2, hypercholesterolemia, statin usage, anxiety, depression, and prior thyroid-associated treatments (thyroidectomy, radioablation). Relative risk between cohorts was calculated for each outcome in the immediate (<6 mo) and short-term (<1 year) following diagnosis of autoimmune hyperthyroidism.
Results :
Of the 36,218 autoimmune hyperthyroidism patients included, 783 were cannabis users, 17,326 were nicotine users, and the rest were control patients without cannabis or nicotine usage. Compared to non-users, cannabis users were more likely to be younger in age, male, African American or Hispanic/Latino, have anxiety or depression, and have prior thyroidectomy. Cannabis users were 1.6 times more likely to develop orbitopathy (p=0.05). Nicotine users were 1.4-2.2 times more likely to develop almost all TED presentations (p<0.02).
Conclusions :
Our findings suggest that cannabis usage is associated with increased incidence of orbitopathy in autoimmune hyperthyroidism patients within 1 year of diagnosis. This study also confirmed a strong correlation of nicotine usage and TED. Further research is needed to directly elucidate the relationship of cannabis usage and TED management to improve patient care.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.