{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T08:06:17Z","timestamp":1785139577077,"version":"3.55.0"},"reference-count":49,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T00:00:00Z","timestamp":1784851200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["European Journal of Ophthalmology"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Understanding the modifiable risk factors for Graves\u2019 orbitopathy (GO) is crucial for its prevention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We searched PubMed, Embase, and Web of Science databases following PRISMA guidelines. Studies reporting the presence of GO compared to patients with Graves\u2019 disease (GD) without orbitopathy or healthy controls were included. Statistical analysis was performed using Review Manager 5.4.1.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Twenty-two studies met the inclusion criteria. Smoking increased the risk of GO, with odds ratios (ORs) of 2.00 (95% CI [1.47, 2.72];\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.0001) for current smokers and 1.77 (95% CI [1.33, 2.37];\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.0001) for former smokers, compared with GD patients without orbitopathy. Thyroidectomy was associated with a higher OR of Graves\u2019 disease without orbitopathy, supporting a protective effect against orbitopathy (OR 2.53; 95% CI [1.03, 6.22];\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.04). However, radioiodine therapy did not show a significant association (OR 0.89; 95% CI [0.42, 1.91];\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.77). Biomarkers, including vitamin D (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.63), FT3 (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.89), FT4 (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.59), and TSH (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.40), showed no significant differences. In comparison to healthy controls, smoking remained a major risk factor for GO (OR 4.81; 95% CI [1.39, 16.70];\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.01), while elevated FT4 (MD 8.87; 95% CI [1.64, 16.10];\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.02) and decreased TSH (MD \u22121.23; 95% CI [-2.25, \u22120.20];\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.02) levels were found in the GO groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our analysis provides a comprehensive understanding of clinical and biomarker-based risk factors to guide targeted prevention strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/11206721261470209","type":"journal-article","created":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T13:36:58Z","timestamp":1784900218000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Risk factors for graves\u2019 orbitopathy: A systematic review and meta-analysis"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-7282-9131","authenticated-orcid":false,"given":"Lidia","family":"Cheidde","sequence":"first","affiliation":[{"name":"Pontifical Catholic University of S\u00e3o Paulo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-7948-154X","authenticated-orcid":false,"given":"Dillan Cunha","family":"Amaral","sequence":"additional","affiliation":[{"name":"Complexo Hospitalar da Universidade Federal do Rio de Janeiro"},{"name":"Universidade Federal do Rio de 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