Electronic Cigarette Use and Thyroid Eye Disease in Autoimmune Hyperthyroidism: A Global Real-World Study
Author: Itay Nitzan
Base Hospital / Institution: Department of Ophthalmology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel
ePoster presentation
Abstract ID: 25-491
Purpose
To evaluate whether electronic cigarette (e-cigarette) use is associated with increased risk of thyroid eye disease (TED) among patients with autoimmune hyperthyroidism.
Methods
Adults diagnosed with autoimmune hyperthyroidism (ICD-10: E05.00) between June 2005 and May 2025 were identified from the TriNetX Global Collaborative Network. The exposed cohort included patients with e-cigarette use (U07.0, F17.20) recorded on ≥2 occasions; those with a history of traditional tobacco use (F17.21, F17.22, F17.29) were excluded. A 1:1 propensity score–matched (PSM) control cohort without e-cigarette or tobacco use was generated based on demographics, comorbidities, thyroid-directed therapies, medication history, and healthcare utilization. Patients with TED-related outcome before the index date were excluded. Primary outcomes were assessed at 1-year post-diagnosis and grouped into: (1) TED-related diagnoses (exophthalmos, eyelid retraction, orbital/eyelid edema, strabismus, optic neuropathy); (2) systemic corticosteroid use; (3) teprotumumab use; and (4) surgical interventions (eyelid repair, tarsorrhaphy, strabismus surgery, orbital decompression). Risk ratios and 95% CIs were calculated from incidence proportions. Sensitivity analyses were performed at 3- and 5-year follow-up intervals.
Results
After PSM, 6,009 patients per group were analyzed. Groups were balanced (standardized mean difference <0.1); 74.0% vs 74.6% were female, and 62.2% vs 63.2% were White in the e-cigarette and control cohorts. E-cigarette users had increased TED diagnoses (3.89% vs 2.68%; RR, 1.46; 95% CI, 1.19–1.79; P = .003), corticosteroid use (10.3% vs 7.4%; RR, 1.39; 95% CI, 1.22–1.59; P < .001, log-rank), and surgical interventions (1.24% vs 0.72%; RR, 1.71; 95% CI, 1.18–2.49; P = .013, log-rank). Teprotumumab use was rare and comparable (0.25% vs 0.33%; RR, 0.75; 95% CI, 0.38–1.46; P = .29, log-rank). Sensitivity analyses showed consistent trends.
Conclusion
E-cigarette use increased TED risk and treatment demand in autoimmune hyperthyroidism. Vaping may represent a preventable contributor to disease burden.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Tehila | Shlomov | Department of Ophthalmology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel |
| Rina | Polak | Department of Ophthalmology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel |
| Ofira | Zloto | Goldschleger Eye Institute, Sheba Medical Center, Ramat Gan, Israel |
| Zvi | Gur | Department of Ophthalmology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel |
