Green Smoke, Red Flag: Cannabis and the Risk of Orbitopathy and Dermopathy in Thyrotoxicosis

Abstract

Background The use of cannabis has been associated with an array of multi-systemic physiological effects. However, the medical literature on the potential role of cannabinoids in the management and outcomes of thyrotoxicosis remains scarce. We studied the association between cannabis use and orbitopathy, dermopathy, and the length of hospital stay for thyrotoxicosis admissions. Methods A thorough analysis was conducted on adult hospitalizations in 2020 with a primary discharge diagnosis of thyrotoxicosis, using data from the Nationwide Inpatient Sample (NIS). To ensure data completeness and consistency, hospitalizations with missing or incomplete information, as well as those involving patients under 18 years of age, were excluded from the study. The remaining study sample was categorized into two groups based on the presence or absence of cannabis use, as determined by ICD-10-CM/PCS codes. Subtypes of orbitopathy, dermopathy, and potential confounding factors were identified based on previous literature and defined using validated ICD-10-CM/PCS codes. The association between cannabis use and the outcomes was evaluated using multivariate regression analysis. The primary focus was on thyroid orbitopathy, while dermopathy and the average length of hospital stay were considered as secondary outcomes. Results A total of 7,210 hospitalizations for thyrotoxicosis were included in the analysis. Among them, 404 (5.6%) were associated with cannabis use, while 6,806 (94.4%) were non-users serving as controls. Cannabis users were predominantly female (227, 56.3%), which was similar to the control group (5,263, 73%), and they were primarily of Black descent. Notably, the cohort of cannabis users was significantly younger than the control group (37.7 ± 1.3 vs. 63.6 ± 0.3). Upon conducting multivariate regression analysis, it was found that cannabis use was linked to a significant increase in the odds of orbitopathy among patients with thyrotoxicosis (AOR: 2.36; 95% CI: 1.12-4.94; P = 0.02). Additionally, a history of tobacco smoking was also correlated with higher odds of orbitopathy in the study (AOR: 1.21; 95% CI: 0.76-1.93; p = 0.04). However, no significant association was observed between cannabis use and the odds of dermopathy (AOR: 0.88; 95% CI: 0.51-1.54; p = 0.65) or the average length of hospital stay (IRR: 0.44; 95% CI: 0.58-1.46; p = 0.40). Conclusion The study identified a significant association between cannabis use and increased odds of orbitopathy in patients with thyrotoxicosis. Additionally, a history of tobacco smoking was also found to be correlated with augmented odds of orbitopathy.