title: [The level of cotinine - marker of tobacco smoking, in patients with hyperthyroidism].
abstract: BACKGROUND
  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.
  
  
  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; > or = 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.
authors.affiliation: Department of Endocrinology and Metabolism, Karol Marcinkowski University of Medical Sciences, Poznan. agata.rat@wp.pl
authors.forename: Agata
authors.initials: A
authors.lastname: Czarnywojtek
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Zgorzalewicz-Stachowiak
authors.forename: Ewa
authors.initials: E
authors.lastname: Florek
authors.forename: Wojciech
authors.initials: W
authors.lastname: Piekoszewski
authors.forename: Izabela
authors.initials: I
authors.lastname: Warmuz-Stangierska
authors.forename: Izabela
authors.initials: I
authors.lastname: Kulińska-Niedziela
authors.forename: Krzesisława
authors.initials: K
authors.lastname: Komar-Rychlicka
authors.forename: Jerzy
authors.initials: J
authors.lastname: Sowiński
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000652:urine; D016022:Case-Control Studies; D003367:Cotinine / Q000652:urine*; D005260:Female; D049970:Graves Ophthalmopathy / Q000209:etiology / Q000652:urine*; D006801:Humans; D008875:Middle Aged; D012907:Smoking / Q000009:adverse effects / Q000652:urine*
chemical_list: D015415:Biomarkers; D003367:Cotinine