Observational studyThe Journal of clinical endocrinology and metabolism2026
Cigarette smoking exposure and clinical outcomes in Graves' disease.
Observational study in The Journal of clinical endocrinology and metabolism, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
1 citing paper in PubMed.
- Role of sex and gender in autoimmune thyroid diseases: mechanisms and knowledge gaps.Reviews in endocrine & metabolic disorders · 2026Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
11 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
contextSmoking is a recognized risk factor for Graves' disease (GD), but its quantitative relationship with disease severity, autoimmunity, and relapse after antithyroid drug (ATD) therapy is unclear.
objectiveTo evaluate the dose-dependent association between smoking exposure and key clinical outcomes in GD.
methodsThis was a single-center observational cohort study conducted in a secondary-care endocrinology unit in the United Kingdom. Consecutive adults with newly diagnosed GD confirmed by suppressed TSH, elevated thyroid hormones, and positive TRAb or diffusely increased scintigraphic uptake were analysed. All 991 eligible patients were included in baseline analyses; 663 completed ≥12 months follow-up after ATD cessation, and 712 contributed to long-term relapse analyses. The main outcome measures were baseline TRAb levels, presence of orbitopathy, and relapse at 12 months and long term, defined as recurrent biochemical hyperthyroidism with elevated TRAb after ATD withdrawal. Other outcomes included additional biochemical, scintigraphic and clinical measures. Exposures were smoking status (non-, ex-, current smoker) and cigarettes/day.
resultsCurrent smokers (27%) had higher TRAb levels at diagnosis (median 7.8 vs 6.6 IU/L in nonsmokers, P = .002) and increased odds of orbitopathy (OR 1.76, 95% CI 1.17-2.64). Each 10 cigarettes/day conferred a 34% (95% CI 10-79%) higher odds of orbitopathy and 60% higher 12-month relapse risk. Smokers also had higher TRAb at ATD cessation. In time-dependent Cox models, excess relapse risk among current smokers was greatest early after ATD withdrawal (HR 1.24 at 6 months) and diminished by 2 years. TRAb mediated only 7% of the smoking-relapse association.
conclusionSmoking is associated with greater autoimmune activity, higher orbitopathy risk, and increased relapse in a dose-dependent manner. Ex-smokers have risks comparable with nonsmokers, supporting cessation or reduction as a meaningful intervention to improve GD outcomes.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.