Smoking and endocrine ophthalmopathy: impact of smoking severity and current vs lifetime cigarette consumption
Abstract
OBJECTIVE Smoking has been associated with an increased incidence of endocrine ophthalmopathy (EO). In this study we examined the relation between smoking severity and the incidence of EO symptoms in patients with Graves’ hyperthyroidism. DESIGN Patients were prospectively followed for at least one year after the onset of hyperthyroidism. Smoking and EO status were evaluated at 3−6‐ months intervals. PATIENTS Two hundred and fifty‐three ambulatory patients with recent onset of Graves’ hyperthyroidism were studied. MEASUREMENTS The incidence of total EO symptoms, proptosis, and diplopia at any time point before and after the occurrence of Graves’ hyperthyroidism was assessed by interview and physical examination. RESULTS Smoking was associated with a 1.3‐fold increase in the overall incidence of symptomatic EO, and a 2.6 and 3.1‐fold increase in the incidence of proptosis and diplopia, respectively. The relative risk increased in parallel with the current number of cigarettes smoked per day. In contrast, lifetime tobacco use was not an independent risk factor for the development of EO symptoms. Former smokers had a significantly lower risk for the occurrence of proptosis and diplopia than active smokers with a comparable lifetime cigarette consumption. CONCLUSIONS Our data suggest that current, but not lifetime, tobacco consumption constitutes a risk for the incidence of proptosis and diplopia in patients with Graves’ hyperthyroidism, and that this risk increases with smoking severity.
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The risk of GO from smoking is proportional to the number of cigarettes smoked per day, and former smokers have significantly lower risk than current smokers, even after adjusting for lifetime cigarette consumption.
“The risk is proportional to the number of cigarettes smoked per day, and former smokers have significantly lower risk than current smokers, even after adjusting for lifetime cigarette consumption (537).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [537]
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“The risk is proportional to the number of cigarettes smoked per day, and former smokers have significantly lower risk than current smokers, even after adjusting for lifetime cigarette consumption (537).”
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“…have more severe GO (3); development or progression of GO after radioactive iodine (RAI) treatment is more frequent in smokers (47, 48); smokers have a delayed or worse outcome of immunosuppressive treatments (47, 49, 50); smoking cessation is possibly associated with a better outcome of GO (51).”
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“As was reported, the odds ratio for both current smokers and exsmokers was high and the GO was more severe in smokers than in nonsmokers [35–37].”
BackgroundOke, I., Reshef, E. R., Elze, T., et al. (2023) · American Journal of Ophthalmology · doi:10.1016/j.ajo.2023.01.020 · Cited by 20 · see citing works
Mohamed, A., Tzoulis, P., Kossler, A. L., & Dosiou, C. (2022) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgac606 · Cited by 19 · see citing works
Recent advances in graves ophthalmopathy medical therapy: a comprehensive literature review
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Tear film break-up patterns in thyroid eye disease
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Graves orbitopathy: a perspective
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Thyroid eye disease- an update
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Compressive Optic Neuropathy in Thyroid Eye Disease
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“Cessation of smoking has been found to reduce risk to that similar to nonsmokers.(3) The most common examination finding in TED is eyelid retraction (90%), followed by exophthalmos (60%), and restrictive extraocular motility (40%).”
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- Authors
- Pfeilschifter, J., & Ziegler, R.
- Affiliations
- Heidelberg University (DE)
- Corresponding author
- Pfeilschifter, Johannes
- Venue
- Clinical Endocrinology
- Publisher
- Wiley
- Published
- 1996-10
- Volume
- 45
- Issue
- 4
- Pages
- 477-481
- ISSN
- 0300-0664 (ISSN-L)
- 1365-2265
- OpenAlex
- W1986559988
- Cited by
- 227
- References
- 0
- Citations by year
- 2026: 5 · 2025: 11 · 2024: 9 · 2023: 11 · 2022: 9 · 2021: 9 · 2020: 12 · 2019: 9 · 2018: 7 · 2017: 4 · 2016: 15 · 2015: 7 · 2014: 17 · 2013: 7 · 2012: 6
- FWCI
- 1.94
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Endocrinology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pathology and Forensic Medicine › Ophthalmology and Eye Disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Neurology › Myasthenia Gravis and Thymoma
- Keywords
- smoking, endocrine ophthalmopathy, Graves' hyperthyroidism, proptosis, diplopia, former smokers, risk factors
- MeSH terms
- Adult, Diplopia, Exophthalmos, Female, Graves Disease, Humans, Male, Middle Aged, Prospective Studies, Risk, Smoking, Incidence
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