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Influence of cigarette smoking on thyroid gland – an update

As someone who became hypothyroid (or at least, more so) after I stopped smoking, papers discussing these things are always of interest. Afraid I missed this when it was published, but better late than not at all.

Influence of cigarette smoking on thyroid gland – an update

Wpływ palenia papierosów na tarczycę – aktualizacja

Nadia Sawicka-Gutaj1, Paweł Gutaj2, Jerzy Sowiński1, Ewa Wender-Ożegowska2, Agata Czarnywojtek1, Jacek Brązert2, Marek Ruchała1

1Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poland

2Department of Obstetrics and Women’s Diseases, Poznan University of Medical Sciences, Poland

Nadia Sawicka-Gutaj M.D., Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Przybyszewskiego St. 49, 60–355 Poznań, Poland, tel.: +48 61 869 13 30 +48 61 869 13 30, fax: +48 61 869 16 82, e-mail: nyha@o2.pl


Many studies have shown that cigarette smoking exerts multiple effects on the thyroid gland. Smoking seems to induce changes in thyroid function tests, like decrease in TSH and increase in thyroid hormones. However, these alterations are usually mild. In addition, tobacco smoking may also play a role in thyroid autoimmunity. Many studies have confirmed a significant influence of smoking on Graves’ hyperthyroidism and particularly on Graves’ orbitopathy. Here, smoking may increase the risk of disease development, may reduce the effectiveness of treatment, and eventually induce relapse. The role of smoking in Hashimoto’s thyroiditis is not as well established as in Graves’ disease. Nonetheless, lower prevalence of thyroglobulin antibodies, thyroperoxidase antibiodies and hypothyroidism were found in smokers. These findings contrast with a study that reported increased risk of hypothyroidism in smokers with Hashimoto’s thyroiditis. Moreover, cigarette smoking increases the incidence of multinodular goitre, especially in iodine-deficient areas. Some studies have examined cigarette smoking in relation to the risk of thyroid cancer. Interestingly, many of them have shown that smoking may reduce the risk of differentiated thyroid cancer. Furthermore, both active and passive smoking during pregnancy might modify maternal and foetal thyroid function.

This review evaluates the current data concerning the influence of cigarette smoking on thyroid gland, including hormonal changes, autoimmunity and selected diseases. These findings, however, in our opinion, should be carefully evaluated and some of them are not totally evidence-based. Further studies are required to explain the effects of smoking upon thyroid pathophysiology. (Endokrynol Pol 2014; 65 (1): 54–62)

Key words: thyroid; smoking; tobacco; nicotine; thyroid hormones; TSH; TSH receptor autoantibodies; Graves’ disease; Hashimoto’s thyroiditis; postpartum thyroiditis


11 Replies

I think I must have developed an underactive thyroid when I gave up smoking 5 years ago. My issue is I started up again in the last 2 years which must be having an impact on my thyroid as I've had my levothyroxine increased in the last month. Staying smoke free is incredibly difficult. I did give up at the start of the year though... 27 days so far!


Well done....keep it up, you can do it! :) Helps if you are not surrounded by others who smoke I must say. I used to gulp down a glass of water or go for a quick walk round the block to distract myself if I got a craving and I was really pleasantly surprised one day when I really didn't care for smoking at all.......and that is when I knew that I had cracked it. :) The day I walked up a very steep cliff path near where I live without practically going blue (the usual situation when I smoked) and groaning and wheezing like Puffing Billy was a very proud and happy day!

It was also around the time when some really odd things were happening to me which I now realise was my hypothyroidism coming to a head and I was diagnosed.

Curious that there might be a connection, though I think mine was undoubtably triggered by prolonged daily stress at work and with health problems within my family making me worry constantly. Maybe the giving up smoking was what tipped the balance completely and it simply couldn't be ignored anymore.


Hmm I can never make my mind up about this lol. My thyroid probs started before I smoked. I can't escape the fact that my autoimmune issues always worsen to a huge extent when I quit and always get much worse which makes it very difficult to want to quit and remain off them.

I quit during the first trimester of my pregnancy and was immediately so ill and my immune system went mental until I started smoking one or two a day again - I know that's an awful thing to do and hard to admit but I truly felt my immune system was going to cause far worse problems. This was also the time when other disorders started to be indicated like addisons/diabeties. My immune system backed down within a week of smoking again as was only seeing if it worked and was then scared to come off them again. I did wait until all the most important body parts of babies rwere fully formed etc - not that this is any excuse but I really did fear what my immune system was doing to her more and whether I could physically carry full term as went stupid crazy. For example, my blistering started to cover my entire body and scalp and were becoming infected needing antibiotic/steroid cream and hair coming out in clumps because of them and multiple abscesses causing systemic infection requiring full spectrum antibiotics and was worried about constant antibiotics/steroids more than smoking to be blunt. Plus the knowledge that my immune system seemed so hyper and knowing that she was likely an incompatible blood type to me never mind other issues my immune system might cause. Additionally, all people I know personally who became hypothyroid during pregnancy had also suddenly quit smoking - not to say I believe this to be evident of any link as no way enough people to tell. Anyway it felt like the right thing to do instinctively and it worked and the rest of the pregnancy was perfect and she came out and has continued to be the healthiest child I know so who knows, maybe I was lucky or maybe I made the right decision????

Since this time, I stopped gluten and many of my autoimmune diseases and other problems disappeared, I did quit for two years after this and felt really really good and my immune system was clearly being behaved as my inflammation markers went to zero throughout this time. I then had to do three gluten trials over a year or so and felt so bad, I started smoking again which helped as usual. I then had other health issues which i believe have now been resolved to some extent so am going to try quitting again soon - my chest certainly hates smoking so even if just for the sake of this body part lol!

Immune issues especially hypothyroidism definitely worsen or begin when people quit smoking as I know too many people personally that has happened to within three months of quitting but I suppose the question is whether or not smoking caused the existence of such problems in the first place and the process speeds up when you quit or whether it is beneficial from the beginning and simply prolongs the onset of something you were inevitably going to get whether you started or not? I'm also very aware that I only started smoking when I had already run out of energy, could no longer get out of bed and was left undiagnosed for a few years as refused any blood tests and told depression - caffeine and nicotine seemed to be the only things that would keep me going or make me feel better sometimes so to be honest thyroid issues probably induced me to start these bad habits in the first place maybe? I always felt maybe my immune system is distracted when I'm smoking as had other nasties to deal with possibly - whatever it does, it definitely dampens my immune system lol????


I have never smoked but I was brought up in a smoking household when young. My sisters who were brought up in different countries had a non smoking childhood and both havensmoked. We all landed up with no gallbladders or thyroids. The same mother though.

Smoking is bad for your heath period. It should read never smoked!

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Very interesting, helvella.

Can you explain what thyroglobulin antibodies mean? I had these in my blood results and didn't know why, or what they mean?

Thank you.

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Thyroglobulin is a protein that makes up a lot of the thyroid.

Normally, it stays within the thyroid. Sometimes thyroglobulin is released into the bloodstream. When this happens, the immune system tries to mop it up. Thyroglobulin antibodies attach to thyroglobulin and make it as something to be removed. One of the causes of the release is autoimmune disease when the contents of the thyroid "spill" out. Other possibilities include physical injury.


Detecting thyroglobulin antibodies identifies that thyroglobulin has been released and is triggering a response from the immune system.

Note: Do not confuse two tests, thyroglobulin antibodies (as above) and thyroglobulin (used in cancer testing).


Thank you helvella,

My thyroglobulin antIbodies were high, last year, when I had thyroid testing (as a favour from sjogrens specialist, GP would not test thyroid as wasn't due!).

Interestingly, it was,the first time, in 25 yrs hypothyroidism patient, that I had antibodies tested. I wanted them tested because rheumatologist kept to telling me protein blood results abnormal... rheumatologist was not interested in me thinking I was suffering thyroid antibodies..but had no explanation..

I can't help wondering, if the proteins and antibodies were more about thyroid than sjogrens. However, no consultant wants to step on others territory and GP was just plain not interested to hear any thoughts concerning thyroid. My tsh was not due, when I became ill, so it was not up for debate lol..

I have never had antibody test since. I have followed advice here, and do not have the darn awful symptoms, since adopting diet and nutritional changes.

Thank you.

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I too find this interesting as my symptoms worsened five years ago when I gave up smoking.

I have Hashimoto’s and I’m gluten free and both antibodies are still high.

I knew there was a link but it sort of coincided with the menopause so it’s difficult to know what causes what.

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Wow. How strange. I’d never connected the two. 17yrs ago I became pregnant so gave up smoking, my, as yet undiagnosed, hashimotos went crazy and I miscarried. Which is when hashi was diagnosed. 2yrs ago I started smoking again, crazy I know, my thyroid antibodies have now disappeared completely.

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I was diagnosed with hypothyroidism some 20 odd years ado ( gp then didn't check for hashimotos) was on 25 mcg and had no major issues ( like i do now) i smoked until i was 50 when it was discovered i had a perforated duodenal ulcer, i stopped smoking at that point, and within 1 year i had put on 2 stone and had to have numerous increases in doses of levothyroxine, (gp still wouldn't test antibodies) i the had a hysterectomy and that too threw my whole system out, i was sent to an endo as gp couldn't jnderstand why my levels wouldn't settle and i was feeling ill, thats when antibodies were checked and i was diagnosed with hashimotos in 2013/4, but those first two years all that had really changed was the surgery and stopping smoking, i read that something in the nicotine kept the antibodies at bay. I do nelieve this to be true . wouldn't go back to smoking mind haha

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me too! I kept stopping, gained weight, started again & felt better.

I think smoking ups the metabolism somehow and masks Thyroid problems. After cutting down to 3- 5 a day I just stopped - good luck to all trying to stop - you can do it!

I also supplemented B3 niacin (nicotinic acid). J :D

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