LETTER
Smoking and Autoimmune Thyroid Disease
Luisa Fernandez-Soto, MD;
Amalia Gonzalez-Jimenez, MD; and
Fernando Escobar-Jimenez, MD
15 June 1997 | Volume 126 Issue 12 | Page 1005
TO THE EDITOR:
Evidence increasingly suggests that smoking has an effect on autoimmune thyroid disease. In particular, smoking has been shown to worsen Graves disease and Graves ophthalmopathy [1]. The exact role of smoking on the autoimmune mechanism is unclear, but smoking is known to have an antithyroid effect [2, 3]. We investigated antithyroid peroxidase antibodies (TPO-Ab) and antithyroglobulin antibodies (Tg-Ab) in a large cohort of healthy pregnant women before 16 weeks of gestation (n = 349). Levels of TPO-Ab were significantly increased (P < 0.001) in the 32 women who smoked more than 10 cigarettes per day before gestation compared with the 73 women who smoked fewer than 10 cigarettes per day (718 ± 659 U/mL and 101 ± 34 U/mL, respectively) or the 244 women who were nonsmokers (99 ± 22 U/mL). Levels of Tg-Ab were significantly increased (P = 0.009) in pregnant women who smoked more than 10 cigarettes per day compared with those who smoked fewer than 10 cigarettes per day (125 ± 105 U/mL and 37 ± 16 U/mL, respectively) or those who were nonsmokers (31 ± 4 U/mL).
Given the effects of pregnancy on autoimmune thyroid disease [4], we recommend screening for TPO-Ab in women who smoke before or during early gestation. Women who are positive for TPO-Ab should be followed serially with testing for free thyroxine and thyroid-stimulating hormone during gestation and the postpartum period because the risk for clinical thyroid disease in women with elevated TPO-Ab levels is great [4].
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Author and Article Information
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University Hospital, Granada, Spain
1. Winja B, Mandahl A, Karlsson FA. Graves' disease, endocrine ophthalmopathy and smoking. Acta Endocrinol. 1993; 128:156-60.
2. Fukuyama H, Nasu M, Murakami S, Sugawara M. Examination of antithyroid effects of smoking products in cultured thyroid follicles: only thiocyanate is a potent antithyroid agent. Acta Endocrinol. 1992; 127:520-5.
3. Bartalena L, Bogazzi F, Tand M, Maneti L, Dell'unto C, Martino E. Cigarette smoking and the thyroid. Eur J Endocrinol. 1995; 133:507-11.
4. Glinoer D, Riahi M, Grun JP, Kinthaert J. Risk of subclinical hypothyroidism in pregnant women with asymptomatic autoimmune thyroid disorders. J Clin Endocrinol Metab. 1994; 79:197-204.
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