Cigarette Smoking and Thyroid Eye Disease

Graves’ ophthalmopathy represents the most frequent extrathyroidal manifestation of Graves’ disease, but it may more rarely also occur in patients with hypothyroid Hashimoto’s thyroiditis or in subjects with no evidence of hyperthyroidism (euthyroid Graves’ disease) (1). In most cases ocular involvement is mild and nonprogressive, but 3-5% of patients have severe expressions of the disease that require aggressive treatment, such as high-dose systemic glucocorticoids, orbital radiotherapy, or orbital decompression (2).