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Statins and thyroid eye disease (TED): a systematic review

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Abstract

Purpose

Thyroid eye disease (TED) is the foremost extrathyroidal manifestation of Graves’ disease (GD). Currently, available treatments do not entirely prevent the long-term consequences of TED and have distinct disadvantages. Therefore, this systematic review explored available evidence regarding the efficacy of statins in preventing and treating TED.

Methods

Relevant studies investigating statin usage in patients with GD or TED were identified by searching Medline (Pubmed and Ovid), Scopus, Web of Science, ProQuest, and Cochrane Library databases (from the database inception to September 2023). The review was done according to the PRISMA statement. Web searching was done independently by two investigators. Two researchers independently extracted the data, and any disagreement was adjudicated by consensus. Based on the study design, the studies’ quality appraisal was done using the Newcastle-Ottawa Scale (NOS) and Version 2 of the Cochrane risk-of-bias tool (RoB2).

Results

The literature search identified 145 publications, of which four met the inclusion criteria (Three retrospective cohort studies and one randomized clinical trial) and were reviewed in full text. The two retrospective cohort studies demonstrated the beneficial effects of statins on TED in newly diagnosed GD Stein et al. showed that statins, regardless of the type, prevent or delay TED (HR: 0.74 (0.65–0.84)), especially in men or treatment duration of more than one year. Nilsson et al. fascinatingly revealed that at least 60 days of statin usage in the preceding year could decrease the risk of TED development by around 40%. One RCT showed a higher treatment response for active moderate-to-severe TED in patients with hypercholesterolemia who took atorvastatin 20 mg in addition to ivGC for 24 weeks without any increase in serious side effects. The retrospective study revealed that the need for reconstructive surgery was reduced in patients with severe TED who received statin therapy.

Conclusion

Statin therapy could be a potential adjunctive modality for preventing and treating TED.

Trial registration

PROSPERO registration number: CRD42022315522.

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Author contributions

RM and ZM conceptualized the research question, contributed to the literature search, and full text screening assessed the quality, extracted the data, and wrote the review. MK and FA participated in the review and editing of the manuscript. ZE contributed to the literature search. All authors contributed to the article and approved the submitted version.

Funding

The study was supported by the Iran University of Medical Sciences (Grant number:23307).

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Authors and Affiliations

  1. Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran

    Ramin Malboosbaf, Zohreh Maghsoomi, Zahra Emami & Mohammad E. Khamseh

  2. Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Fereidoun Azizi

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  1. Ramin Malboosbaf
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  2. Zohreh Maghsoomi
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Correspondence to Zohreh Maghsoomi.

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Malboosbaf, R., Maghsoomi, Z., Emami, Z. et al. Statins and thyroid eye disease (TED): a systematic review. Endocrine (2024). https://doi.org/10.1007/s12020-023-03680-5

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