Bartalena, Luigi, Marcocci, Claudio, Tanda, Maria Laura, Manetti, Luca, Dell'Unto, Enrica, Bartolomei, Maria Pia, Nardi, Marco, Martino, Enio, and Pinchera, Aldo
Background: It is unclear whether smoking affects the course of Graves ophthalmopathy and therapeutic outcomes. Objective: To observe smoking behavior in a randomized study of the effect of radioiodine therapy on ophthalmopathy and in a case series of patients with Graves ophthalmopathy receiving orbital radiation therapy and glucocorticoids. Design: Randomized, single-blind study of smoking and mild ophthalmopathy after radioiodine therapy (study 1) and a retrospective cohort study of the association between smoking and response of severe ophthalmopathy to treatment (study 2). Setting: University medical center. Patients: 300 patients with mild ophthalmopathy (study 1) and 150 patients with severe ophthalmopathy (study 2). Intervention: In study 1, patients received radioiodine alone or radioiodine and a 3-month course of oral prednisone (initial dosage, 0.4 to 0.5 mg/kg of body weight per day). In study 2, patients received high-dose oral prednisone for 6 months (initial dosage, 80 to 100 mg/d) and underwent orbital radiation therapy by linear accelerator (cumulative dose, 20 Gyper eye over 2 weeks). Measurements: Degree of ophthalmopathy was assessed by overall evaluation (inflammatory changes, proptosis, extraocular muscle dysfunction, corneal involvement, and optic neuropathy). Results: In study 1, ophthalmopathy progressed in 4 of 68 nonsmokers (5.9% [95% CI, 3% to 9%]) and 19 of 82 smokers (23.2% SCI, 13% to 33%]) who received radioiodine alone (P = 0.007). Ophthalmopathy was alleviated in 37 of 58 nonsmokers (63.8%, [CI, 51% to 78%]) and 13 of 87 smokers (14.9% SCI, 10% to 26%]) who received radioiodine plus prednisone (P [is less than] 0.001). In study 2, 61 of 65 nonsmokers (93.8% [CI, 90% to 98%]) and 58 of 85 smokers (68.2% SCI, 57% to 78%]) responded to treatment (P [is less than] 0.001). Conclusions: Cigarette smoking increases the risk for progression of ophthalmopathy after radioiodine therapy and decreases the efficacy of orbital radiation therapy and glucocorticoid therapy., Cigarette smoking contributes to the progression of Graves ophthalmopathy and may reduce the effectiveness of treatment for the disease. Graves disease is a type of hyperthyroidism, and some patients develop bulging eyes and other ocular symptoms. Researchers evaluating the effects of smoking on the outcomes of 450 patients treated for Graves ophthalmopathy. Eye symptoms progressed in 6% of nonsmokers and 23% of smokers. Radiation and corticosteroid drug therapies were effective in 94% of nonsmokers and 68% of smokers with Graves ophthalmopathy.