Smoking is a risk factor for Graves’ disease. It also increases the risk of complications such as eye problems.

Smoking can cause a multitude of health issues throughout the body.

Although people commonly associate smoking with lung and heart complications, it can also affect the thyroid gland. Smoking can increase the likelihood of developing Graves’ disease, an autoimmune disorder that results in hyperthyroidism or the overproduction of thyroid hormones.

This article explores smoking and Graves’ disease, its effects on medications, and how a person can quit.

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Smoking is a risk factor for Graves’ disease. Other risk factors include:

  • being assigned female at birth
  • having a family history of Graves’ disease
  • living with another autoimmune disease, such as rheumatoid arthritis

One theory is that smoking can trigger immune responses that may eventually lead to Graves’ disease. This is an autoimmune condition that causes the thyroid gland to become overactive and speed up many bodily functions.

Smoking cigarettes may also exacerbate Graves’ disease symptoms such as:

The chemicals in cigarettes, such as nicotine, can stimulate the immune system in a way that worsens autoimmune responses, leading to more severe symptoms of hyperthyroidism.

Moreover, smokers with Graves’ disease are more likely to develop thyroid eye disease (TED).

Smoking may influence how medications for Graves’ disease work. Substances in cigarettes can alter the absorption and metabolism of drugs. To counteract this, doctors may adjust the dosage for people who smoke.

Doctors use antithyroid medications to help treat Graves’ disease. They work to reduce the thyroid gland’s excessive production of thyroid hormones.

Methimazole and propylthiouracil are some examples of antithyroid medications. People typically use them for up to 18 months.

Is there a risk of relapse?

According to the British Thyroid Foundation (BTF), a single course of antithyroid drugs is successful in 30% to 50% of cases, and people have no further problems with their thyroid. However, the thyroid can become overactive again, known as a relapse.

The risk of a relapse is low after 12 months but can occur many months or years later. People who smoke are also around three times more likely to relapse after treatment than nonsmokers.

Smoking is also associated with a reduced response to treatments for TED, making managing eye symptoms more challenging.

There is a strong association between smoking and TED, also known as Graves’ ophthalmopathy.

The BTF notes that people who smoke have double the risk of developing TED — for heavy smokers, the risk increases to eight times. Furthermore, if a person has radioactive iodine treatment and smokes, they are four times more likely to develop TED.

The primary symptom of Graves’ eye disease is bulging eyes. A person may also experience:

  • dry, red, or irritated eyes
  • swollen eyelids
  • eyelids that do not close properly
  • double vision
  • light sensitivity
  • eye pain or pressure
  • problems moving the eyeball

Rarely, swelling around the eyes can press on the optic nerve and lead to vision loss.

One reason for the increased risk of TED is that smoking may affect the oxygen supply to tissues in the back of the eye, making the area more prone to inflammation.

Learn more about how to treat TED.

While some people may perceive vaping as a safer alternative to smoking, scientists do not fully understand the effect on long-term health and the thyroid.

Vaping involves inhaling vapor from e-cigarettes that contain nicotine and other chemicals. Therefore, it could still provoke an immune response or interfere with thyroid function and how medications work.

The Food and Drug Administration (FDA) has linked vaping to lung issues, and although the effects on Graves’ disease are unknown, people should approach vaping with caution.

Quitting smoking is a crucial step for people with Graves’ disease. Smoking cessation can lead to a significant improvement in the symptoms of Graves’ disease and TED.

People who quit smoking may also respond better to treatment. Healthcare professionals can support people as they decide to quit smoking. They may recommend:

These strategies can help reduce withdrawal symptoms, manage cravings, and address the behavioral aspects of smoking.

Find out more about ways to quit smoking.

Smoking can increase the risk of developing Graves’ disease. It may also worsen symptoms and lead to eye complications. Furthermore, it can complicate treatment responses and make a relapse more likely.

The substances in cigarettes and possibly in vaping products can affect the autoimmune processes underlying Graves’ disease. Given these risks, smokers living with this condition may consider quitting.