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From the Journals

HPV Linked to Thyroid Eye Disease

Patients with the eye disorder were more likely to have had low-risk HPV before hyperthyroidism diagnosis.

Conexiant

Patients with thyroid eye disease may have a higher prevalence of low-risk human papillomavirus infections compared with matched controls with autoimmune hyperthyroidism alone, according to a case-control study.

The findings could add clinical evidence to recent laboratory research suggesting that molecular mimicry involving human papillomavirus (HPV) may contribute to thyroid eye disease (TED) pathogenesis. In the current study, patients with TED had more than 1.5 times the risk of prior low-risk HPV infections compared with controls.

In the study, investigators used the TriNetX electronic health record platform, which aggregates data from approximately 150 million patients, to identify cases and controls. Cases were defined as patients with autoimmune hyperthyroidism and clinical signs of TED, including exophthalmos, eyelid retraction, visual field defects, or motility deficits. Controls were matched patients with autoimmune hyperthyroidism without TED.

Among 246,957 patients with autoimmune hyperthyroidism, 26,824 of them had TED. After matching, each group contained 26,823 patients with similar demographic characteristics (mean age = 51.9 years, 75.4% female).

The association was specific to low-risk HPV diagnosed prior to the onset of autoimmune hyperthyroidism—approximately three times more common compared with infections occurring after diagnosis. New HPV infections after hyperthyroidism diagnoses showed no statistically significant difference between the groups, and high-risk HPV strains showed no association regardless of timing.

In a secondary analysis comparing 201 patients with TED and low-risk HPV to matched TED controls without HPV, those with prior HPV infections had higher rates of orbital decompression surgery (13.4% vs 5.5%). Rates of corticosteroid use, vision loss, eyelid retraction, and strabismus didn't differ between the groups.

The investigators acknowledged limitations inherent to electronic health record databases, including inconsistency and incompleteness of documentation.

"Further research into the role of HPV in TED could lead to improvements in prevention and management of this life-changing disorder," lead study author Moshe I. Weber, BA, and colleagues concluded.

One study author reported receiving funding from Revance Therapeutics for an unrelated study, with payment made to the institution.

Source: JAMA Ophthalmology