Graves’ orbitopathy: the importance of statin therapy

Abstract

Background. Graves’ orbitopathy is the most common extrathyroidal autoimmune disorder, predominantly caused by hyperthyroidism. Prevention and development of an individualized treatment plan involve the use of statins and the management of risk factors: age, sex, smoking, hypercholesterolemia and comorbidities. Objective(s). The evaluation of the benefits of statin therapy in patients with Graves’ orbitopathy in order to draw the medical community’s attention to an important aspect of disease management. Materials and methods. A meta-analysis was performed on 14 scientific publications, including preclinical and clinical studies, meta-analyses, and articles published within the last 5 years. Keywords used in the literature search across PubMed, MedScape, Google Scholar, and HINARI included “thyroid eye disease,” “Graves’ orbitopathy,” and “statin therapy.” Results. The analyzed studies show that patients aged 40–60 years treated with statins experience a 40% reduction in the risk of developing Graves’ orbitopathy and a 44% reduction in the incidence of exophthalmos. One study suggests that combining intravenous glucocorticoids with statins, versus monotherapy, decreases progression of exophthalmos, clinical activity score, diplopia, and eyelid retraction. Atorvastatin or rosuvastatin significantly minimizes the required dose of teprotumumab, surgery, and diplopia. Further investigation of the pathogenic mechanisms and mechanical effects of statins remains a priority for future research. Conclusion(s). Early diagnosis and treatment of hyperthyroidism, along with proper risk factor management, reduces incidence and improves prognosis. Introducing statins into the initial treatment combined with intravenous glucocorticoids represents an important aspect of preventive treatment.