MON-431 - Glucocorticoid Use and Risk of Glycemic Complications in Thyroid Eye Disease: A Nested Case-Control Study

Background: Thyroid eye disease (TED) is an autoimmune disorder characterized by acute orbital inflammation and subsequent fibrotic changes. Intravenous (IV) glucocorticoids are recommended for active, moderate‑to‑severe TED but are associated with metabolic adverse effects, including glycemic dysregulation. Real-world evidence quantifying this risk in TED is limited.

Objective: To examine the association between glucocorticoid use and the risk of glycemic complications among patients with TED in the United States.

Methods: We conducted a retrospective nested case-control study using Komodo Health database (January 2016–December 2024). Adults (≥18 years) with TED were identified using ≥1 hyperthyroidism diagnosis and ≥1 eye signs/symptoms code, with the earliest eye symptom used to define the TED diagnosis date. Patients with prior glycemic complications or glucose-lowering medications used during the 1-year baseline before TED diagnosis date were excluded. Glycemic complications occurring after TED diagnosis included initiation of insulin or antidiabetic agents, incident type 2 diabetes or hyperglycemia, identified using ≥1 inpatient or ≥2 outpatient ICD-10 codes. Cases were TED patients with glycemic complications; controls were matched 1:4 using incidence density sampling on age, sex, and TED cohort entry date. Exposure was defined as first oral and/or IV glucocorticoid (prednisone-equivalent) use after TED diagnosis and before the glycemic event date. Conditional logistic regression model was used to estimate adjusted odds ratios (aORs) with 95% confidence intervals (CIs), controlling for region, comorbidities and concomitant medications.

Results: The study included 12,814 cases and 31,378 controls. Mean (SD) age was 54.4 (15.2) years for cases and 54.0 (15.6) years for controls; most were female (77.6% of cases and 80.2% of controls). Baseline statin use (28.3% vs 22.9%) and hyperlipidemia (30.7% vs 24.4%) were more prevalent among cases. Glucocorticoid exposure among cases was associated with an increased risk of glycemic complications compared with controls across all routes of administration: aOR of 1.20 (95% CI: 1.14–1.26) for oral, 1.15 (95% CI: 1.04–1.27) for IV, and 1.30 (95% CI: 1.22–1.39) for combined oral and IV use.

Conclusion: Glucocorticoid use in TED is associated with increased risk of glycemic complications, underscoring the need for careful risk-benefit assessment, glucose monitoring, and consideration of steroid-sparing approaches.

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