If you have thyroid eye disease, quitting smoking may help improve the effectiveness of treatments, slow disease progression, and prevent complications like cataracts.

Thyroid eye disease (TED) is an inflammatory eye disorder that occurs when your body mistakenly attacks the tissues around the eyes.

It affects up to 1 in 2 people with Graves’ disease, an autoimmune condition in which the immune system attacks the thyroid gland. TED is sometimes called Graves’ orbitopathy or Graves’ ophthalmopathy.

Smoking greatly increases the risk of having TED and experiencing more severe symptoms, especially if you have Graves’ disease.

According to a 2021 research review, people who smoke now or have smoked in the past are at least twice as likely to develop TED than those who have never smoked.

Both first- and secondhand smoking have been found to increase the risk of TED. The more cigarettes you smoke per day, the higher your risk.

Researchers aren’t exactly sure why smoking increases the risk of Graves’ disease and TED.

One hypothesis is that smokers have a higher blood concentration of a chemical called serum thiocyanate than nonsmokers. This chemical may prevent the transport of iodide into thyroid cells. Iodide is essential for thyroid health.

An older 2016 study found that smoking may also contribute to TED because it could:

  • reduce blood flow behind the eye
  • reduce available oxygen to the body’s tissues
  • increase inflammation in the body

Below are seven reasons to quit smoking if you have TED.

Treatment for TED will depend on the severity of your condition, but it may include:

  • lubricating eye drops
  • selenium supplements
  • corticosteroids

According to the Endocrine Society, smoking may have a negative effect on treatment response.

For instance, a small 2023 study found that smokers treated with a biologic called teprotumumab had worse disease severity than nonsmokers.

Smokers undergoing radioactive iodine therapy are also four times more likely to develop TED than nonsmokers, according to the British Thyroid Foundation.

The risk is proportional to the number of cigarettes you smoke per day. The more you smoke, the greater the risk.

Along with quitting smoking, an early diagnosis of TED may help slow the progression to a more severe form of the disease.

Severe symptoms of TED, like vision problems and eye misalignment, may negatively affect your quality of life and be difficult to treat.

By slowing progression, quitting smoking may prevent the need for more aggressive treatment, like surgery.

Quitting smoking reduces the risk of developing exophthalmos (bulging eyes) and diplopia (double vision) in people with Graves’ disease.

The risk of experiencing these two symptoms may also increase in proportion to the number of cigarettes smoked per day.

However, quitting smoking may greatly lower your risk of developing TED or worsening symptoms, such as bulging eyes and double vision.

Along with TED, smoking increases your risk of other serious eye conditions that may cause vision loss or blindness.

According to the Centers for Disease Control and Prevention (CDC), these include:

  • Macular degeneration: This eye disease affects central vision and can lead to vision loss if left untreated. People who smoke are twice as likely to develop it than nonsmokers.
  • Cataracts: These are cloudy areas in the eye that can cause blurry vision. They can worsen over time. Cataracts require surgery and can cause blindness if not treated.

Smoking damages nearly every organ in the body. Smoking also increases your risk of developing:

  • cardiovascular disease
  • lung cancer
  • various lung diseases
  • autoimmune diseases, like rheumatoid arthritis and lupus

Many people with Graves’ disease go into remission after an initial course of treatment. But, nearly 1 in 2 people experience a relapse after the initial treatment.

A 2017 review of 54 clinical trials with a total of 7,595 participants with Graves’ disease found that smoking was strongly associated with relapse.

Most relapses occur between 6 and 18 months after stopping the treatment with antithyroid medications.

In some cases, TED may require surgery, such as:

  • orbital decompression surgery
  • strabismus (eye muscle) surgery
  • eyelid retraction surgery

All surgeries carry risks. But the World Health Organization (WHO) found that smokers who quit about 4 weeks or more before their surgery have a lower risk of complications. They also have better outcomes 6 months later.

Quitting also reduces your risk of experiencing complications with anesthesia.

In 2020, the Food and Drug Administration (FDA) approved a new treatment for TED called Tepezza (teprotumumab).

Some insurance policies state that you must currently be nonsmoking, actively enrolled in a smoking cessation program, or at least have had a discussion with your doctor about quitting before insurance will cover this drug.

People with TED who continue to smoke respond less well to treatments. Quitting has been shown to help improve people’s outlooks and reduce the risk of complications.

Smoking is the biggest risk factor associated with TED. The risk increases the more you smoke.

If you have TED and smoke, consider speaking with a healthcare professional to learn more about ways to quit smoking. You can also call 800-QUIT-NOW (800-784-8669) for free support.