Association of Wind Exposure and Air Pollution with Thyroid Eye Disease: First Nationwide Multicenter Evidence from China

Background Thyroid eye disease (TED) is an autoimmune condition associated with thyroid dysfunction that affects orbital tissues. Up to 8.2% of patients with TED develop sight-threatening disease. However, the role of ambient environmental exposures in aggravating TED remains poorly understood. Methods Thus, we conducted a nationwide, multicenter study, including 3,422 patients from nine hospitals across China. The clinical records were integrated with the spatial distribution of ambient environmental factors derived from satellite observations, including air pollution, meteorological variables, and visual proxies. Then, a qualitative screening of key environmental factors potentially related to TED severity was performed using the random forest model, followed by quantitative analysis with a logistic regression model. Furthermore, associations between environmental exposure and thyroid function were examined using generalized additive models. Results The results indicated that higher TED severity was associated with increases in wind speed (per 0.1 m/s, OR = 1.117), CO (per 1 mg/m³, OR = 1.033), NO₂ (per 10 µg/m³, OR = 1.139), and PM₂.₅ (per 10 µg/m³, OR = 1.041). Notably, interactions between wind speed and air pollutants synergistically aggravated disease severity (all p for interaction < 0.001). Subgroup analyses revealed that the impact of wind speed was more pronounced in older patients, females, smokers, and those with longer disease duration. Moreover, wind speed showed a linear association with fT3 (p = 0.003) and a nonlinear relationship with fT4 (p < 0.001), suggesting a potential mechanistic pathway. Conclusions Our study provides the first large-scale evidence linking ambient environmental exposure to TED. Long-term exposure to high wind speed and ambient air pollution may aggravate TED severity through thyroid dysfunction. These findings highlight the potential value of environmental interventions targeting wind exposure, particularly in regions with high air pollution, to control TED progression in vulnerable populations.