The Effects of Cigarette Smoking on the Development of Thyroid Eye Disease
The effects of cigarette smoking on the development of thyroid eye disease in patients with Graves’ disease: A clinical review
Summary points * Thyroid eye disease (TED) is thought to be caused by the stimulation of retro-orbital TSH receptors by thyrotropin receptor stimulating antibodies.
* There is a strong association between cigarette smoking and the development and progression of thyroid eye disease.
* Cigarette smoking has adverse effects upon treatments for Graves’ disease and thyroid eye disease.
* Optimum management of thyroid eye disease is multidisciplinary and early referral is vital.
* Advice and support for smoking cessation is important and should be provided by those managing the patients with thyroid eye disease and Graves’ disease.
Introduction
Graves’ disease (GD) is a relatively common form of hyperthyroidism. It is the most common form of hyperthyroidism in young women and makes up around 85% of cases. It is due to an autoimmune process in which the thyroid stimulating hormone (TSH) receptors on thyroid follicular cells are stimulated by thyrotrophin receptor antibodies (TRAb) resulting in excess production of the thyroid hormones, tri-iodothyronine (T3) and thyroxine (T4). 1,2,3 The Wickham Study carried out in the United Kingdom found the incidence in the general population to be 100-200 cases per 100,000 individuals per year. Like many autoimmune diseases GD is more common in women than in men.4
Thyroid eye disease is the most frequent extra-thyroidal manifestation of GD with 25-50% of those affected showing a degree of eye involvement.5 The impact of tobacco smoking upon the development of TED and the management of patients suffering from TED is an area of much debate. This essay will explore the effect of tobacco smoking on the incidence and disease progression of TED in those with GD as well as on challenges surrounding patient management. Appropriate interventions that may benefit future
Summary points * Thyroid eye disease (TED) is thought to be caused by the stimulation of retro-orbital TSH receptors by thyrotropin receptor stimulating antibodies.
* There is a strong association between cigarette smoking and the development and progression of thyroid eye disease.
* Cigarette smoking has adverse effects upon treatments for Graves’ disease and thyroid eye disease.
* Optimum management of thyroid eye disease is multidisciplinary and early referral is vital.
* Advice and support for smoking cessation is important and should be provided by those managing the patients with thyroid eye disease and Graves’ disease.
Introduction
Graves’ disease (GD) is a relatively common form of hyperthyroidism. It is the most common form of hyperthyroidism in young women and makes up around 85% of cases. It is due to an autoimmune process in which the thyroid stimulating hormone (TSH) receptors on thyroid follicular cells are stimulated by thyrotrophin receptor antibodies (TRAb) resulting in excess production of the thyroid hormones, tri-iodothyronine (T3) and thyroxine (T4). 1,2,3 The Wickham Study carried out in the United Kingdom found the incidence in the general population to be 100-200 cases per 100,000 individuals per year. Like many autoimmune diseases GD is more common in women than in men.4
Thyroid eye disease is the most frequent extra-thyroidal manifestation of GD with 25-50% of those affected showing a degree of eye involvement.5 The impact of tobacco smoking upon the development of TED and the management of patients suffering from TED is an area of much debate. This essay will explore the effect of tobacco smoking on the incidence and disease progression of TED in those with GD as well as on challenges surrounding patient management. Appropriate interventions that may benefit future
References: 8. Metcalfe RA, Weetman AP Stimulation of extra-ocular muscle fibroblasts by cytokines and hypoxia: possible role in thyroid-associated opthalmopathy Clin Endocrinol. 1994;40;1;67-72:Abstract 9 16. Taylor T, Lader D, Bryant A, Keyse L, Joloza MT. Smoking-related behaviour and attitudes, 2005. London: Office for National Statistics, 2006. www.statistics.gov.uk/downloads/theme_health/Smoking2005.pdf 17