Mitigating the risks: addressing smoking cessation in thyroid eye disease.

Objective: This study aimed to assess the effectiveness of verbal counselling and varenicline in achieving smoking cessation among patients with thyroid eye disease (TED) and to identify predictive factors associated with successful smoking cessation.

Methods and analysis: A cross-sectional analysis of data from the Iran TED (IrTED) Registry was conducted. Patients' demographics and TED severity/activity were recorded. As a routine at the TED clinic in Rassoul Akram Hospital, since 2020, all smoking patients have undergone smoking cessation verbal counselling in the first and almost every subsequent visit session. The effectiveness of verbal counselling was assessed through a telephone survey. Retrospectively, the association between successful smoking cessation and disease severity/activity was evaluated. Prospectively, patients who failed or refused to quit smoking after counselling were offered varenicline. Acceptance, compliance and adherence rates were determined.

Results: While 379/685 patients of the IrTED 2013-2023 database (55.32%) reported no tobacco exposure, the remaining were active (n=117, 17.08%), passive (n=134, 19.56%) and former smokers (n=55, 8.02%). In 2020-2023, 73 active tobacco-smoking patients with TED were enrolled, all of whom received verbal cessation counselling at their first and subsequent visits. On the follow-up phone call, 51/73 were contacted, and 25/51 (49.01%) reported successful smoking cessation after verbal counselling. The remaining 26/51 smokers were offered varenicline (on the phone call); however, only 7/26 (26.92%) attended the prescription session. Of these patients, 3/7 (42.85%) completed the first month of treatment, and just 1/3 (33.33%) finished the 3-month course, successfully quitting smoking until the final follow-up (18 months). One patient (14.28%) reported constipation, and another one reported sleep paralysis (14.28%) as an adverse event.

Conclusion: Verbal counselling demonstrates effectiveness in smoking cessation for patients with TED, with nearly half of smokers successfully quitting the habit. Among those who failed to quit after verbal counselling, varenicline showed limited effectiveness, indicating poor compliance and motivation deficit.