PURPOSE: To describe the association of smoking status with surgical intervention for TED at the population-level. DESIGN: Retrospective cohort study. METHODS: SETTING: : US clinical data registry STUDY POPULATION: : All adults (age ≥18 years) with Graves disease in the Intelligent Research in Sight (IRIS®) Registry (1/1/2013-12/31/2020). OBSERVATION: Surgical intervention for TED, stratified into orbital decompression, strabismus surgery, and eyelid recession surgery. OUTCOME MEASURES: The Kaplan-Meier estimated five-year cumulative probability for each surgical intervention. Multivariable Cox regression was used to evaluate the association between smoking status and each surgical intervention, adjusting for age, sex, race, ethnicity, and geographic region. RESULTS: This study included 87,923 patients. Median age was 59 years (IQR, 48-68 years); 81% were female patients. Current smokers had a greater five-year cumulative probability of orbital decompression (3.7% vs.1.9%; p<0.001), strabismus surgery (4.6% vs.2.2%; p<0.001) and eyelid recession (4.1% vs.2.6%; p<0.001) compared to never smokers. After adjusting for demographic factors, current smokers were at greater risk of orbital decompression (HR, 2.1; 95% CI 1.8-2.4; p<0.001), strabismus surgery (HR, 2.0; 95% CI 1.8-2.3; p<0.001), and eyelid recession (HR, 1.7; 95% CI 1.5-1.9; p<0.001) than never smokers. Former smokers were at higher risk of each type of surgery for TED, though at lower levels than current smokers. CONCLUSIONS: Smoking was associated with increased risk of surgical intervention for TED in the IRIS Registry. Former smokers were at a lower risk than current smokers, supporting the role of smoking cessation on lowering the burden of surgical disease at the population-level.