Patients with two of the most serious, manifestations of Graves disease–acropachy and dermopathy–are three times more likely to have a history of tobacco use and are five times more likely to be current smokers than patients with another thyroid disease, Hashimoto’s thyroiditis.
A small study presented at the annual meeting of the American Association of Clinical Endocrinologists found that 31 of 39 patients with acropachy (79%), 81 of 102 patients with dermopathy (79%), and 13 of 46 patients with Hasbimoto’s thyroiditis (28%) had a history smoking.
More than half of patients with dermopathy or acropachy reported that they were current smokers, compared with 9% of patients with Hashimoto’s thyroiditis.
“Several reports have indicated that tobacco use is a risk factor for Graves’ ophthalmopathy,” noted Dr. Vahab Fatourechi of the Mayo Clinic, Rochester, Minn., in a poster presented at the meeting.
But the frequency of tobacco use in patients with even more severe manifestations of Graves’ disease had never been studied. These manifestations include acropachy, an inflammatory disorder of connective tissue that involves clubbing of the fingers and toes and can lead to elephantiasis, and dermopathy, also known as pretibial or localized myxedema, which is an infiltrative condition of the dorsum of the legs and feet characterized by hyperpigmented patches and plaques.
Dr. Fatourechi and coinvestigator Mitra M. Fatourechi, a medical student at the University of Minnesota, Minneapolis, compared age- and sex-matched patients with acropachy, dermopathy, or Hashimoto’s thyroiditis, finding a striking association between the more severe conditions and current or past tobacco use.
“Although the pathogenesis of this association is unclear and suggested modification of the immune process by smoking needs further confirmation, a strong case can be made for considering tobacco use as a risk factor for severity of autoimmune manifestations of Graves’ disease,” Dr. Fatourechi said. “Patients with Graves’ disease should be strongly advised against smoking.”
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