Vol 57, No 6 (2006)
Original paper
Published online: 2006-11-29
The level of cotinine - marker of tobacco smoking, in patients with hyperthyroidism
Endokrynol Pol 2006;57(6):612-618.
Abstract
Introduction: Orbitopathy associated with Graves’ disease
TAO (thyroid associated orbitopathy) is likewise connected
with environmental factors including tobacco smoking.
Tobacco smoking increases the risk of ophthalmologic pathology
and leads to the orbital tissue damage due to the
hypoxia.
The aim of the study was to correlate the concentration of
urinecotinine (marker of tobacco smoking) in Graves’ disease
patients with TAO with points received on the Fagerström
questionnaire.
Materials and methods: Thirty women with different degree of exacerbation of TAO in Graves’ disease (34.28 ± 12.04 yr.) were examined. As control we used 29 women with Graves’ disease without TAO (29.35 ± 12.33 yr.). The diagnosis was established according to level of TSH and level of thyrotropin receptor antibodies (TRAb). Measure of tobacco smoking or exposure to second hand tobacco smoke ETS (environmental tobacco smoke) carried out according to the Fagerström questionnaire, and measured cotinine level (the major metabolite of nicotine in urine). The level of clinical ophtalmopathy was measured according to the CAS (Clinical Activity Score) scale and degree of progression of TAO according to American Thyroid Association (NOSPECS scale). Additionally increase of exophthalmus was measured using the Hertl’s exophthalmometer.
Results: In the group with TAO: 19 (63.3%) persons had mild exophthalmos (according to CAS), medium in 13 (43.3%) patients, and pronounced exophthalmous in 10 (33%) patients. There was statistically significant difference in the level of TRAb (18.4 ± 8.2 vs. 5.1 ± 3.4 IU/l; p < 0.0001) between TAO and controls. There was no correlation between TSH (0.6 ± 0.02 vs. 0.4 ± 0.04; p = 0.18) and fT4 (38.8 ± 29.3 vs. 26.1 ± 17.3; p = 0.026) in both analyzed groups. Smokers and non-smokers with TAO had no statistically significant in level of TRAb (Mann-Whitney test p = 0.16). No correlation was found between smoking tobacco (cotinine level) and the level of TRAb in patients with TAO (Pearson r = 0.28 p = 0.58). There was a statistically significant difference between the level of urine cotinine in smoking patients with TAO in the highest level of ophthalmopathy exacerbation (> 24 mm; ≥ 4 points according to CAS) and those without TAO (Mann-Whitney’s test p = 0.04).
Conclusions: 1. In patients with Graves’ disease with TAO the highest score of tobacco smoking has been found in persons with the highest ophthalmopathy exacerbation.
2. Estimation of cotinine concentration in urine is the most objective and useful method of tobacco smoking.
Materials and methods: Thirty women with different degree of exacerbation of TAO in Graves’ disease (34.28 ± 12.04 yr.) were examined. As control we used 29 women with Graves’ disease without TAO (29.35 ± 12.33 yr.). The diagnosis was established according to level of TSH and level of thyrotropin receptor antibodies (TRAb). Measure of tobacco smoking or exposure to second hand tobacco smoke ETS (environmental tobacco smoke) carried out according to the Fagerström questionnaire, and measured cotinine level (the major metabolite of nicotine in urine). The level of clinical ophtalmopathy was measured according to the CAS (Clinical Activity Score) scale and degree of progression of TAO according to American Thyroid Association (NOSPECS scale). Additionally increase of exophthalmus was measured using the Hertl’s exophthalmometer.
Results: In the group with TAO: 19 (63.3%) persons had mild exophthalmos (according to CAS), medium in 13 (43.3%) patients, and pronounced exophthalmous in 10 (33%) patients. There was statistically significant difference in the level of TRAb (18.4 ± 8.2 vs. 5.1 ± 3.4 IU/l; p < 0.0001) between TAO and controls. There was no correlation between TSH (0.6 ± 0.02 vs. 0.4 ± 0.04; p = 0.18) and fT4 (38.8 ± 29.3 vs. 26.1 ± 17.3; p = 0.026) in both analyzed groups. Smokers and non-smokers with TAO had no statistically significant in level of TRAb (Mann-Whitney test p = 0.16). No correlation was found between smoking tobacco (cotinine level) and the level of TRAb in patients with TAO (Pearson r = 0.28 p = 0.58). There was a statistically significant difference between the level of urine cotinine in smoking patients with TAO in the highest level of ophthalmopathy exacerbation (> 24 mm; ≥ 4 points according to CAS) and those without TAO (Mann-Whitney’s test p = 0.04).
Conclusions: 1. In patients with Graves’ disease with TAO the highest score of tobacco smoking has been found in persons with the highest ophthalmopathy exacerbation.
2. Estimation of cotinine concentration in urine is the most objective and useful method of tobacco smoking.
Keywords: tobacco smokinghyperthyroidismGraves’ diseasecotinine
