Introduction: Graves’ orbitopathy (GO) is a frequent extra-thyroidal manifestation of autoimmune dysthyroidism. Moderate-to-severe forms impair quality of life and visual prognosis. Smoking has been identified for some 30 years as one of the main risk factors. Recently, effective targeted therapies have emerged for GO, but are costly. The aim of this study was to evaluate the assessment of smoking status and management of smoking cessation in a population of moderate-to-severe Graves’ orbitopathy in real life.

Method: This was a 2-center retrospective study conducted jointly at the university hospitals of Montpellier and Nîmes (France), which included patients treated with bolus corticosteroids, rituximab and/or tocilizumab for moderate-to-severe GO from 2008 to 2019.

Results: Smoking status was assessed in 78 patients, 78.2% of whom were women, with a median age of 47.5 years. Overall, 60.3% were either current smokers or weaned smokers. For current smokers, 6 smoking cessation consultations were proposed, but only 2 were attended. Use of smoking cessation aids was limited. Finally, cessation was achieved in 25 patients, 11 of whom resumed smoking.

Discussion: Compared with the general population, there was a higher incidence of smoking in this series (60.3% vs. 30.2%), which seems to confirm that active smokers have more moderate-to-severe forms of GO. This study highlights the inadequacy of management of smoking cessation. Developing structured care pathways for patients with GO involving ophthalmologists, endocrinologists and smoking cessation specialists, and establishing official national guidelines for smoking cessation in GO, might achieve more effective cessation. Prospective studies are required to evaluate the effectiveness of this kind of partnership for smoking cessation in GO.