Vaping and Thyroid Eye Disease: What Do We Know?
If you have thyroid eye disease (TED), you may already have been advised to stop smoking. But this often leads to another question: “Can I vape instead?”
We know from strong evidence that smoking can make TED worse, which is why stopping smoking is so important. When it comes to vaping, however, the answer is less clear.
There is still very little research looking specifically at vaping in people with TED. This means that, at the moment, we cannot say that vaping is safe for people with thyroid eye disease.
Why is smoking important in TED?
Thyroid eye disease is mainly linked to Graves’ disease, an autoimmune condition.
In TED, the immune system attacks tissues around and behind the eyes. This causes inflammation and swelling.
Smoking is a well-established risk factor for TED. People who smoke are more likely to develop TED and are more likely to have severe disease.
Smoking can also increase the risk of TED developing or getting worse after radioactive iodine treatment. People who smoke may also have a poorer or slower response to some treatments.
For these reasons, EUGOGO recommends that all people with Graves’ hyperthyroidism should be urged not to smoke, whether or not they have thyroid eye disease.
What about vaping?
This is where the evidence is much less certain.
There has not yet been enough research involving people with TED to tell us whether vaping increases the risk of developing TED or can make existing TED worse.
However, a lack of evidence of harm does not mean that vaping has been shown to be safe.
Research is still developing.
What is in vape aerosol?
Vaping does not produce harmless water vapour.
E-cigarettes heat a liquid to create an aerosol, which is then breathed into the lungs.
Depending on the product and how it is used, this aerosol can contain nicotine and other substances, including very small particles, flavouring chemicals, volatile organic compounds and metals.
Heating vape liquids can also produce other chemicals.
The substances present and the amounts produced can vary between different liquids, flavours, devices and the way a device is used.
Some of these substances have the potential to cause inflammation or damage to cells.
Scientists are still studying what repeated exposure to vape aerosol may mean for health over the longer term.
Why could this matter in thyroid eye disease?
TED is an inflammatory autoimmune disease.
The tissues and muscles behind the eyes can become inflamed and swollen. Special cells called orbital fibroblasts play an important part in this process.
These cells can produce substances that cause the tissues behind the eyes to swell and hold on to water.
This is one reason researchers are interested in whether substances that affect inflammation or these cells could be important in TED.
Has vaping been studied in thyroid eye disease?
There has been some early laboratory research.
A 2022 study looked at orbital fibroblasts taken from people with Graves’ orbitopathy — another name for thyroid eye disease — and compared them with cells from people without the condition.
Researchers exposed the cells to extracts from conventional cigarette smoke, heated tobacco products and e-cigarette vapour.
They found that e-cigarette vapour affected the behaviour of the cells in the laboratory. The orbital fibroblasts from people with Graves’ orbitopathy also appeared more sensitive to low levels of exposure than cells from people without the condition.
This is interesting because orbital fibroblasts are important cells in TED.
However, there is an important limitation.
This was a laboratory study of cells. It was not a study of people with TED who vape.
It therefore cannot tell us whether vaping causes TED, makes TED worse or affects how well TED treatment works.
More research involving people with TED is needed.
What about nicotine?
Many vapes contain nicotine, although some do not.
Nicotine is addictive and has effects throughout the body. However, we do not currently have enough evidence to say what role nicotine itself may have in thyroid eye disease.
Vape aerosol also contains substances other than nicotine. This means that looking at nicotine alone does not answer the question of how vaping might affect TED.
So, is vaping safe if I have TED?
We do not currently know.
There is not enough clinical research in people with thyroid eye disease to say that vaping is safe for TED.
There is also not enough evidence to say that vaping has the same effect on TED as cigarette smoking.
These are different questions, and it is important not to make claims that the research cannot yet support.
What we do know is that vape aerosol is not simply water vapour, and early laboratory research shows that e-cigarette vapour can affect cells that are involved in thyroid eye disease.
For this reason, vaping should not be assumed to be harmless for people with TED.
What if I currently smoke?
The evidence about cigarette smoking and TED is much stronger.
EUGOGO recommends that people with Graves’ disease should be encouraged to stop smoking.
If you smoke and are considering using a vape or another product to help you stop, speak to your GP, pharmacist or stop smoking service about the options available to you.
The important aim for someone with Graves’ disease or TED is to stop smoking.
What we know — and what we don’t
We know:
- smoking is an established risk factor for thyroid eye disease
- smoking is linked with more severe TED
- smoking can affect the outcome of some TED treatments
- vape aerosol can contain nicotine and other potentially harmful substances
- laboratory research has shown that e-cigarette vapour can affect orbital fibroblasts
We don’t yet know:
- whether vaping increases the risk of developing TED
- whether vaping makes existing TED worse
- whether vaping affects TED treatment
- what the long-term effects of vaping may be for people with TED
The important message
There is strong evidence that smoking can make thyroid eye disease worse.
There is much less evidence about vaping.
Early laboratory research gives us a reason to investigate vaping and TED further, but it does not tell us what happens to people with TED who vape.
Until we have better research, we cannot say that vaping is safe for thyroid eye disease, and it should not be assumed to be harmless.
Where to Find Support
Living with Thyroid Eye Disease can feel confusing and overwhelming, especially as many of the changes happening behind the eyes are not always visible to others.
TEDct provides information, peer support, and an online community for people affected by Thyroid Eye Disease, including the Facebook group Thyroid Eye Disease Support UK.
About this information
Written by: Josian Phillips, TEDct
Published: 24 August 2026
Last evidence review: 24 August 2026
Clinical guidance: EUGOGO Guidelines