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In women with overt hypothyroidism, though the biochemical differences in hormonal levels become indistinguishable between smokers and nonsmokers, probably due to the gross abnormality of the hormones themselves, smoking still affects the consequences of hypothyroidism, as smokers have more lipid abnormalities and cardiovascular risk compared to nonsmokers.[] SMOKING, GRAVES' DISEASE, AND GRAVES' ORBITOPATHY Smoking has been strongly related to graves hyperthyroidism and the evidence is growing.[] The evidence is even more robust for Graves' orbitopathy (GO), an autoimmune inflammatory condition characterized by upper eyelid retraction, edema, erythema, and proptosis.[] The association was first described in 1987[] and multiple recent studies and reviews now conclude that there indeed is a causal association.[] In patients with Graves' hypothyroidism, smoking increased the relative risk of orbitopathy by a factor of 1-9, and the RR rises up to 7-7 for orbitopathy among those with Graves' hyperthyroidism

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