Smoking Affects Graves' Disease TreatmentNEW YORK, Oct. 15 (Reuters) -- Smoking reduces the effectiveness of treatments for the eye complications of Graves' disease, according to researchers in Italy.
Graves' disease is an autoimmune disease characterized by an enlarged thyroid. Patients with the disease can also develop eye symptoms, including abnormal protrusion of the eyeball, blurred or double vision.
Cigarette smoking is a risk factor for eye complications of Graves' disease, Dr. Luigi Bartalena of the University of Pisa and colleagues explain in the October 15th issue of Annals of Internal Medicine. They set out to determine whether or not smoking also affected treatment outcomes in patients with the disorder.
The researchers reviewed the outcomes of 300 Graves' disease patients with mild eye symptoms and 150 with severe eye complications. Patients in the first group were treated with radioiodine, either alone or in combination with steroid therapy. Patients in the second group all received steroids and underwent radiation therapy targeting the eye.
Among patients with mild eye symptoms, smokers were more likely to experience disease progression after radioiodine therapy compared with nonsmokers, with rates of 23.2% and 5.9%, respectively. In addition, radioiodine plus steroid therapy was more than four times more effective in alleviating mild eye symptoms in nonsmokers than in smokers, Bartalena and colleagues report.
The same association between treatment outcome and smoking status was observed in patients with more severe forms of the disease. According to the report, the combination of high-dose steroids and eye irradiation was more likely to offer benefits to nonsmokers than to smokers.
The findings "suggest that cigarette smoking increases the risk for progression of (eye complications) after radioiodine therapy and decreases the efficacy of orbital irradiation and steroids," the Italian investigators conclude. They recommend that patients with eye complications of Graves' disease "should be strongly encouraged to refrain from smoking."
SOURCE: Annals of Internal Medicine 1998;129:632-635.
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