Cigarette smoking exposure and clinical outcomes in Graves' disease
Authors' conclusion
Smoking is associated with greater autoimmune activity, higher orbitopathy risk, and increased relapse in a dose-dependent manner. Ex-smokers have risks comparable with nonsmokers, supporting cessation or reduction as a meaningful intervention to improve GD outcomes.
Study context
- Population
- Consecutive adults with newly diagnosed Graves' disease (GD) (suppressed TSH, elevated thyroid hormones, and positive TRAb or diffusely increased scintigraphic uptake), UK663 completed ≥12 months follow-up
- Participants
- 991 adults
- Exposure
- Smoking exposure in GD
- Outcome
- Baseline TRAb levels, presence of orbitopathy, and relapse (recurrent biochemical hyperthyroidism with elevated TRAb after ATD withdrawal)
- Follow-up
- 12 months and long term
Methodological detailssingle-centre, secondary-care endocrinology unit
- Single-centre
- Secondary-care endocrinology unit
Main finding
As reported in the abstract
TRAb at diagnosis; orbitopathy; relapse
Current smokers vs NonsmokersOdds ratio (95% CI)
Orbitopathy
1.76(1.17–2.64)
- Relapse at 6 months after antithyroid drug (ATD) withdrawal; excess risk diminished by 2 years
- HR 1.24
- Higher odds of orbitopathy per 10 cigarettes/day
- 34% (95% CI 10-79%)
- Higher 12-month relapse risk per 10 cigarettes/day
- 60%
Observational data: associations, not effects.
Further findings
TRAb at ATD cessation
- Smokers had higher TRAb at ATD cessation
Mediation by TRAb of smoking-relapse association
- Proportion mediated by TRAb
- 7%
Original publication
Cigarette smoking exposure and clinical outcomes in Graves' disease. J Clin Endocrinol Metab. Published 12 February 2026. doi:10.
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