Risk Factors and Clinical Characteristics of Graves’ Disease Associated with Thyroid Eye Disease

A BSTRACT Objective: To evaluate the risk factors and clinical features of diffuse toxic goiter associated with endocrine ophthalmopathy. Materials and Methods: A cross-sectional study was conducted at an outpatient clinic in Astana from September to December 2025. The study included 55 adult patients with Graves’ disease (GD). Based on ophthalmologist examinations and EUGOGO recommendations and Clinical Activity Score criteria, the patients were divided into two groups: GD with endocrine orbitopathy (EOP) ( n = 27) and GD without EOP ( n = 28). The clinical examination included a physical examination, assessment of complaints, medical history, blood pressure, and heart rate. Laboratory tests included thyroid function tests and determination of thyrotropin receptor antibodies (TRAb). Results: The groups were comparable for age, gender, and ethnicity. No significant differences were observed in thyrotoxicosis-related symptoms, age at onset, or disease duration. Patients with thyrotoxicosis had significantly higher exophthalmometry values ( P < 0.0001) and higher TRAb levels ( P = 0.040). Energy drink consumption was significantly higher in the thyrotoxicosis group (25.9% vs. 3.6%; odds ratio OR = 9.45; P = 0.025). In multivariable logistic regression analysis, energy drink consumption (OR = 11.59, 95% confidence interval CI: 1.19–112.77, P = 0.035) and hereditary predisposition (OR = 4.78, 95% CI: 1.24–18.50, P = 0.023) were associated with EOP. Two-way analysis of variance revealed a combined effect of a positive family history and carbohydrate metabolism disorders on the severity of exophthalmos, while stress and alcohol consumption were associated with orbital asymmetry. A moderate negative correlation was found between the severity of exophthalmos and the age at onset. Conclusions: Thyroid orbitopathy in GD is largely independent of the severity of thyrotoxicosis and results from a multifactorial interaction involving immunological, behavioral, genetic, and metabolic factors. Certain factors, including energy drink consumption and hereditary predisposition, may be associated with EOP, while these findings should be interpreted with caution and require confirmation in larger studies.