How does smoking increase the risk of graves disease

Tobacco contains cyanide, which when smoked transforms into the substance thiocyanate.
There are three main ways that thiocyanate affects thyroid function:

 It inhibits the uptake (absorption) of iodine into the thyroid gland, reducing the production of
the thyroid hormones thyroxine (T4) and triiodothyronine (T3).

 It directly inhibits hormone production by interfering with the synthesis process in the
thyroid gland.

 It increases the excretion of iodine from the kidneys, increasing the risk of thyroid gland
inflammation and such constitutional symptoms as fever, nausea, and stomach pain.

the impact of thiocyanate on the thyroid gland is mediated by nicotine in cigarettes. Nicotine
actually has a converse effect on the thyroid gland, activating the function and undercutting some
of the inhibitory effects of thiocyanate.The persistent inflammation caused by cigarette smoking
can also result in the enlargement of the gland itself, which is of particular concern to people
living with Graves' or Hashimoto's disease.Graves' disease, a form of autoimmune
hyperthyroidism characterized by thyroid enlargement (goiter), occurs twice as frequently in
smokers as in non-smokers. Moreover, in people living with the disease, smoking is associated
with faster disease progression, the deterioration of symptoms, worsening eye disease, and a
poorer response to thyroid treatment.
 References

Shomon, M. (2022, October 22). The Cause-and-Effect Dangers of Smoking and Thyroid
Disease. Verywell Health. https://www.verywellhealth.com/cigarette-smoking-and-thyroid-
disease-3231732