Association of Lower Alanine Transaminase (ALT) and Aspartate Aminotransferase (AST) Levels With Eyelid Edema in Graves' Orbitopathy: A Retrospective Cross-Sectional Study.

BACKGROUND

Graves' orbitopathy (GO) is a common autoimmune disorder affecting the eye muscles and orbital tissues, often leading to eyelid edema. The potential role of liver enzymes in this condition remains unclear.

METHODS

We conducted a retrospective cross-sectional study on 303 GO patients from Wuhan Union Hospital between 2015 and 2025. Participants were grouped according to the presence of eyelid edema. Univariable and multivariable logistic regression models were applied to evaluate the associations between alanine transaminase (ALT), aspartate aminotransferase (AST), and eyelid edema, with adjustments for sex, age, and lymphocytes.

RESULTS

Our analysis showed that lower ALT and AST levels were significantly associated with an increased likelihood of eyelid edema in the fully adjusted models (ALT per 10 U: OR = 0.813, 95% CI = 0.678-0.975; AST: OR = 0.681, 95% CI = 0.489-0.947). A linear dose-response relationship was observed: for each 10-unit decrease in ALT or AST, the observed prevalence of eyelid edema increased by 18.7%-31.9%.

CONCLUSION

This study demonstrated an association between liver enzymes (AST and ALT) and eyelid edema in GO patients. The findings suggest a potential link between liver function and the pathogenesis of GO-related edema. Further prospective studies are required to clarify the causal relationship, explore the underlying mechanisms, and assess the clinical utility of liver enzymes as biomarkers for GO severity or progression.