Background The effect of smoking on thyroid function is controversial,and its effect on thyroid hormone action is unknown. We investigatedthe effects of cigarette smoking in women with various gradesof hypothyroidism and in normal women.
Methods We studied 138 normal women and 135 women with primaryhypothyroidism, of whom 84 had subclinical hypothyroidism and51 overt hypothyroidism. Sixty of the women with hypothyroidismwere reevaluated during thyroxine therapy. The women were categorizedas smokers or nonsmokers according to their responses to a questionnaire.Thyroid function was evaluated by measurements of serum thyrotropin,free thyroxine, and triiodothyronine. Peripheral thyroid hormoneaction was assessed by a clinical score and measurements ofankle-reflex time and serum lipids and creatine kinase.
Results Among the women with subclinical hypothyroidism, thesmokers had a higher mean (±SD) serum thyrotropin concentration(21.3±16.6 vs. 12.7±7.2 mU per liter, P = 0.004)and a higher ratio of serum triiodothyronine to serum free thyroxine(by 30 percent, P = 0.003) than the nonsmokers. Their serumconcentrations of total cholesterol and low-density lipoprotein(LDL) cholesterol were higher (by 16 percent, P = 0.013; and28 percent, P = 0.003, respectively). Among the women with overthypothyroidism, the serum concentrations of thyrotropin, freethyroxine, and triiodothyronine were similar in the smokersand nonsmokers. As compared with the nonsmokers, the smokershad a clinical score indicating a greater degree of hypothyroidism(P<0.001), higher serum concentrations of total and LDL cholesterol(by 25 percent, P<0.001; and 24 percent, P = 0.002, respectively),longer ankle-reflex time (by 25 percent, P<0.001), and higherserum concentrations of creatine kinase (by 236 percent, P<0.001).There were dose–response relations between smoking andserum concentrations of total and LDL cholesterol, serum creatinekinase concentrations, and ankle-reflex time in the women withovert hypothyroidism, and between smoking and serum concentrationsof total and LDL cholesterol in the women with subclinical hypothyroidism.
Conclusions Smoking increases the metabolic effects of hypothyroidismin a dose-dependent way. This may be explained by alterationof both thyroid function and hormone action.
Source Information
From the Division of Endocrinology, Diabetology, and Metabolism, Department of Medicine (B.M., H.Z., J.-J.S.), and the Hormone Laboratory, Department of Chemical Pathology (P.H.), University Hospital, Basel, Switzerland; and the Wolfson Research Laboratories, Department of Clinical Chemistry, Queen Elizabeth Medical Centre, Egbaston, Birmingham, United Kingdom (J.G.R.).
Address reprint requests to Dr. Müller at the Division of Endocrinology, Diabetology, and Metabolism, Department of Medicine, University Hospital, Petersgraben 4, CH-4031 Basel, Switzerland.
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