Thyroid Eye Disease: Why It Is Important to Stop Smoking
If you have thyroid eye disease (TED) and you smoke, stopping smoking is one of the most important things you can do to help protect your eyes.
What is thyroid eye disease?
Thyroid eye disease is mainly linked to Graves’ disease.
Graves’ disease is an autoimmune condition. This means the immune system, which normally protects you from infection, attacks healthy parts of the body by mistake.
In Graves’ disease, the immune system attacks the thyroid gland. In thyroid eye disease, it also attacks the tissues around and behind the eyes.
This can cause swelling and inflammation.
You may have:
- dry, gritty or watery eyes
- red or swollen eyes and eyelids
- pain or pressure around the eyes
- eyes that look more open or bulging
- double vision
- changes in your sight
Why does smoking make thyroid eye disease worse?
Research has found a strong link between smoking and thyroid eye disease.
People who smoke are more likely to develop thyroid eye disease. If they do develop it, they are more likely to have severe eye problems.
The risk also increases with the amount smoked.
What does the science tell us?
Cigarette smoke contains thousands of chemicals. These chemicals can affect the immune system and increase inflammation in the body.
This is especially important in thyroid eye disease because the immune system is already causing inflammation around the eyes.
Smoking may also reduce the amount of oxygen reaching the tissues around the eyes.
Low oxygen levels can make cells behind the eyes produce substances that cause more swelling and inflammation. Some of these cells can also make substances that hold on to water. This makes the tissues behind the eyes swell.
There is limited space inside the eye socket. When the tissues and muscles behind the eye swell, they can push the eye forwards. This can cause bulging eyes, discomfort and double vision.
In severe thyroid eye disease, the swelling can sometimes put pressure on the nerve that carries messages from the eye to the brain. This can threaten sight.
Smoking can also change the way the immune system works. This may help explain why thyroid eye disease is often more severe in people who smoke.
Does smoking affect treatment?
Yes.
Research shows that some treatments for thyroid eye disease may not work as well in people who continue to smoke.
Smoking is particularly important if you are considering radioactive iodine treatment for Graves’ disease. Radioactive iodine can sometimes make thyroid eye disease worse, and the risk is greater in people who smoke.
Your healthcare team will talk to you about this and may recommend treatment to reduce this risk.
Will stopping smoking help?
Yes.
Stopping smoking reduces an important risk factor for thyroid eye disease.
The sooner you stop, the better. But it is worth stopping at any stage, even if you have smoked for many years.
You should also try to avoid second-hand cigarette smoke.
Getting help to stop smoking
Stopping smoking can be difficult. There are treatments and support that can make it easier.
Your GP, pharmacist or NHS Stop Smoking Service can help you find the best way to stop.
The important message
Smoking and thyroid eye disease are a harmful combination.
Smoking can increase inflammation around the eyes, increase the risk of severe thyroid eye disease and make some treatments less effective.
If you have thyroid eye disease and you smoke, stopping smoking is one of the most important things you can do to help protect your eyes and your sight.
What about vaping?
If you are thinking about stopping smoking, you may be wondering whether you can swap cigarettes for vaping. We know that smoking can make thyroid eye disease worse, but the evidence about vaping and TED is much less clear.
We have looked at what the research tells us so far, what we still do not know, and what this means if you have TED.
Read our article: Can I vape if I have thyroid eye disease?
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