Which modifiable factor is most strongly associated with progression to severe thyroid eye disease and with poor response to treatment?

• A High dietary iodine intake
• B Female sex
• C Young age at onset of hyperthyroidism
• D Cigarette smoking ✓

Explanation

Cigarette smoking is the strongest modifiable risk factor for thyroid eye disease: smokers have several-fold higher risk of developing orbitopathy, greater severity, higher risk of compressive optic neuropathy, and reduced response to both radioiodine and orbital radiotherapy. Female sex increases incidence of Graves disease itself but is not modifiable and does not predict severity as strongly. Counselling cessation is a mandatory part of managing every patient with Graves orbitopathy.

Reference: Kanski's Clinical Ophthalmology, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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