Smoking and Prevention of Thyroid Eye Disease

Current smoking (but not lifetime tobacco use) is associated with Graves’ hyperthyroidism and even stronger with Graves’ ophthalmopathy (or Thyroid Eye Disease, TED). The strength and consistency of the association, the presence of a dose-response relationship, the temporality and specificity as well as the biological plausibility of the association strongly suggest a causal relationship. Exposure of cultured human orbital fibroblasts (the target cells of the orbital autoimmune attack) to cigarette smoke extract increases dose-dependently hyaluronic acid secretion and differentiation into mature fat cells. Smoking is not related to serum concentrations of TSH receptor antibodies, but the more you smoke, the more severe the ophthalmopathy is. Extraocular muscle volume (but not orbital fat volume) is greater in current smokers than in nonsmokers. Smoking cessation most likely plays a significant role in the primary, secondary and tertiary prevention of TED. Questionnaire surveys suggest a decrease in the prevalence and severity of TED, in line with the secular fall in smoking prevalence.