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Increase in protrusion of the eyes in patients treated with pioglitazone
The background of the study. One feature of Graves’ eye disease is protrusion of the eyes (exophthalmos), caused by enlargement of adipose tissue normally present behind the eyes. One factor known to stimulate adipose-tissue growth is peroxisome proliferator–activated receptor gamma (PPAR-
), a factor that stimulates the activity of several genes. Drugs such as pioglitazone and rosiglitazone (thiazolidinedione drugs used to treat diabetes mellitus) activate PPAR- and therefore stimulate adipose-tissue growth. In this study, the effect of pioglitazone on exophthalmos was studied in patients with type 2 diabetes.
How the study was done. The study subjects were 36 patients with diabetes that was poorly controlled despite therapy with a sulfonylurea drug and metformin. The patients were treated with pioglitazone, 30 or 45 mg daily, in addition to the sulfonylurea and metformin, for 26 weeks. The degree of exophthalmos was measured at base line and 26 weeks by a single examiner.
The results of the study. There was an increase in exophthalmos in most patients during the 26-week study period; the median increase was 1 mm. Twenty-three patients (64 percent) had an increase of <2 mm, and thirteen patients (36 percent) had an increase of 
2 mm. None had other signs of Graves’ eye disease such as swelling around the eyes or limitation of eye movements during the study.
The conclusions of the study. Patients with diabetes who are treated with a thiazolidinedione drug may have an increase in protrusion of their eyes.
The original article. Dorkhan M, Lantz M, Frid A, Groop L, Hallengren B. Treatment with a thiazolidinedione increases eye protrusion in a subgroup of patients with type 2 diabetes. Clin Endocrinol (Oxf) 2006;65:35-9.
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Measurements of serum thyrotropin-receptor antibodies may predict the severity of Graves’ eye disease |
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| Thyroid Digest Index | | | November 2006 Thyroid Digest |
