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Smoking and Thyroid Eye Disease

Reviewed by: HU Medical Review Board | Last reviewed: October 2021

People who smoke are at a significantly increased risk of developing thyroid eye disease (TED). TED is an autoimmune disease where the tissues surrounding the eyes are mistakenly attacked by the body’s own immune system. This leads to symptoms of inflammation, including swelling, pain, bulging of the eyes, and irritation.1

Normal thyroid gland function

Your thyroid is a small gland found at the bottom of your neck, just below your Adam’s apple. The thyroid releases thyroid hormones. These hormones play important roles in nearly every bodily function. The main job of the thyroid gland is metabolism, or the speed at which your body cells work.2,3

A small gland in your brain called the pituitary gland makes and releases a hormone called thyroid-stimulating hormone (TSH). TSH tells the thyroid how much thyroid hormones (known as T3 and T4) to make.4,5

Your body likes to be in a state of balance. If T3 and T4 levels drop too low, the pituitary gland makes and secretes more TSH. This causes the thyroid to make more thyroid hormones.4,5

What is Graves’ disease?

In Graves’ disease, abnormal immune cells attack the thyroid gland. The thyroid responds by making an excessive amount of thyroid hormone. Too much thyroid hormone leads to an overactive thyroid.4,5

Up to half of those with Graves’ disease develop TED. Despite their similarities, TED and Graves’ disease are different conditions requiring separate treatments.4-6

How does smoking impact thyroid function?

Smoking may play a role in how the body’s immune system reacts to its own cells. Autoimmune diseases, like TED, occur when the body’s own immune system mistakes healthy cells for cells like germs or harmful invaders. In TED, the immune system attacks healthy tissues surrounding the eyes.1,7

Many studies have shown that smoking greatly increases the risk of TED, especially in those with Graves’ disease.6

Why is stopping smoking important?

If you smoke, you may have already thought about stopping. Everyone has their own reasons for why they want to quit. Some of these reasons include:6,8

  • Your overall health and wellbeing. Smoking is a leading cause of preventable illness and death.
  • Decrease your risk of getting TED. People who smoke are up to 8 times more likely to get TED than people who do not smoke.
  • Slow the progress of TED. In 1 study, 4 out 10 people who smoked had worse symptoms of TED compared to those who did not smoke.

Are there treatments or therapies that can help a person quit smoking?

There are drugs available that can help a person stop smoking. Nicotine replacement products deliver a small amount of nicotine that can help reduce the craving for tobacco. The amount of nicotine is tapered off over time to break the physical addiction. Nicotine replacement products include:9

  • Gum
  • Lozenges or tablets
  • Skin patches
  • Nasal sprays
  • Inhalers

Other types of prescription medicines do not deliver any nicotine. Instead, they work in different ways to reduce a person’s desire to smoke. Support and therapy can also make a big impact on helping a person stop smoking, such as:9

  • Counseling
  • Support from family and friends
  • Advice from doctors and nurses
  • Guidance and support from a pulmonary rehabilitation program
  • Support groups with other people who are in the process of quitting smoking

What other tips might be helpful?

  • If a treatment or strategy for quitting does not work, do not give up – try another one.
  • Many people have to try several times in order to successfully quit.
  • Try to change your daily routine to avoid situations where or when you would always smoke in the past.

Other resources

Your doctor or TED specialist can give you more information about local resources and support networks for help in quitting smoking.

There are also many helpful resources available online, such as:

  • Smoke-Free
  • Freedom from Smoking
  • Be Tobacco Free

The American Lung Association also offers a free phone service called the Lung HelpLine and Tobacco QuitLine, which is available at 1-800-LUNGUSA (586-4872).

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