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To the Editor: Cigarette smoking increases the risk of complications of Graves disease, such as ophthalmopathy and relapse after treatment with antithyroid drugs.¹ Anecdotally, patients with Graves disease who smoke appear to respond more slowly to treatment with carbimazole. We therefore retrospectively compared the decline in concentrations of thyroid-stimulating hormone (TSH)–receptor antibody and thyroid hormones in smokers and nonsmokers during carbimazole therapy.

Methods

We studied 59 consecutive patients (25 smokers and 34 nonsmokers) meeting inclusion criteria who attended the Endocrine Clinic, Royal Infirmary, Edinburgh, United Kingdom, between January and April 2007 during the first 12 months of carbimazole therapy for Graves disease (TABLE). Carbimazole was used in an initial maximum dose of 40 mg/d and at review reduced according to thyroid hormone and TSH concentrations. TSH-receptor antibody, free thyroxine (FT₄), and total triiodothyronine (T₃) concentrations were measured every 4 to 6 weeks. TSH-receptor antibodies were measured . . . [Full Text of this Article]

Moffat J. Nyirenda, MRCP
Endocrinology Unit
Queen's Medical Research Institute
University of Edinburgh
Edinburgh, United Kingdom

Peter N. Taylor, MRCP
Endocrine Clinic
The Royal Infirmary of Edinburgh

Mary Stoddart, MIBMS; Geoffrey J. Beckett, PhD, FRCPath
Clinical Biochemistry
University of Edinburgh

Anthony D. Toft, MD
anthony.toft@luht.scot.nhs.uk
Endocrine Clinic
The Royal Infirmary of Edinburgh

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