Thyroid Eye Disease (Graves Disease)

Graves disease is one of the conditions that causes the body to attack itself, aka an autoimmune disorder, resulting in abnormal thyroid function. One of the effects of this condition is thyroid eye disease, which may affect one or both of your eyes.

What Is Thyroid Eye Disease (TED)?

Thyroid disease is a condition where your immune cells attack your thyroid gland, which results in an overproduction thyroid hormone. This autoimmune disease leads to enlargement of your thyroid gland and increased metabolism. This hypermetabolic state leads to thyroid disease or Graves disease symptoms, which are composed of rapid or irregular pulses or heartbeat, high blood pressure, excessive sweating, irritability, weight loss, fatigue, heat intolerance, hair loss and changes in hair quality.

Eye changes also occur as one of the many thyroid disease symptoms, which can range from mild to severe. Thyroid eye disease may occur even when your thyroid hormone level is low or normal, although most patients with thyroid disease or Graves disease symptoms have abnormally elevated hormone levels (hyperthyroidism) accompanied by the presence of specific antibodies in the blood. Up to 20% of patients with thyroid disease have changes in eyesight.

Thyroid eye disease/Graves disease symptoms

Eye symptoms in thyroid disease may affect one or both eyes. They are caused by the swelling and pushing of tissues in the eye socket, which moves your eyeball forward. This may also result in:

  • Drying, irritation and reddening of the cornea (front the eyeball)
  • Aching of the affected eye
  • Bulging of the eye may give you an appearance of staring
  • Double vision may occur when the muscles that control eyeball movement become swollen
  • Blurring of vision, with colors appearing less vivid

When to see a doctor:

Consult an eye specialist when your eye symptoms seem to be getting worse within a few weeks. It is also advisable to see a doctor when:

  • You experience blurring of vision that does not improve with blinking or alternately covering and opening each eye.
  • Colors are not as vivid as they used to be, or you note a difference in the brightness of colors when comparing your vision in each eye.
  • You have double vision when looking downward or forward.
  • You need to tilt your head sideways or backwards to avoid double vision.

What Causes Thyroid Eye Disease (TED)?

Thyroid eye disease, also known as Graves' ophthalmopathy, is a common manifestation of Graves disease, a condition that is caused by hyperthyroidism. It results from carbohydrate build-up in the skin, though the cause of it is unknown yet. It is believed that antibodies that cause thyroid disease may affect the tissues surrounding your eyes.

Thyroid eye disease symptoms often appear as hyperthyroidism develops, but they may also develop after many months or years later. These may also occur even when there is no hyperthyroidism.

Up to one million Americans develop thyroid eye disease every year. Women are 5-6 times more likely to develop the disease compared to men. Cigarette smoking also significantly increases your risk of getting thyroid disease, and often causes more severe thyroid disease or Graves disease symptoms that may threaten vision.

What Are the Treatment Options of Thyroid Eye Disease (TED)?

Inflammation of the tissues affected in thyroid eye disease may improve without treatment. However, some symptoms such as eye bulging, which is caused by swollen tissues may remain. The goal of treatment is to reduce tissue damage and prevent complications.

With the help of an ophthalmologist (eye doctor) and an endocrinologist (a specialist on hormones), your thyroid eye disease treatments may include:

1. Medicines

  • Eye lubricants or artificial tears for mild symptoms in the early stage of the disease.
  • Immunosuppressive drugs to regulate immune system function, such as steroids (prednisolone). Other medicines to counteract common side-effects of steroids may also be given, like omeprazole, to protect the stomach lining.
  • Intravenous steroids for severe eye disease.

2. Surgical Treatment

  • Decompression surgery to prevent damage to the optic nerve, which connects the eyeball to the brain. This procedure relieves pressure on the nerve and prevents loss of eyesight.
  • Surgery to reduce eye bulging, which allows the eyeball to settle back into its socket.
  • Surgery to repair stretched eye muscles or eyelid surgery.

3. Other Types of Treatment

  • Use of modified eye glasses or prism to manage problems with double vision.
  • Radiotherapy to reduce eye swelling, often conducted in combination with other forms of treatment.
  • Other medical treatment for thyroid disease may include tablets, radioactive iodine or thyroid gland surgery.

What Else Can You Do? 

Aside from conventional medical and surgical treatments, there are other steps you can do to improve symptoms of your thyroid eye disease. These include:

  • Quit smoking. Patients who smoke tend to have worse symptoms that do not respond well to treatment, while those who do not smoke or stop smoking are more likely to have better thyroid function and fewer symptoms.
  • Control fluctuations in thyroid hormone levels. Avoid hypothyroidism (low thyroid hormone levels) by taking your blood tests regularly and following your doctor’s advice on taking your medications.
  • Ask your doctor for a referral to an eye specialist center. This is very important especially for people who have severe symptoms of thyroid eye disease.
  • Sleep with your head elevated. This will help reduce the eye congestion and improve puffiness around your eyes.
  • Use sunglasses. This will help reduce discomfort from bright lights.
  • Correct your vision for driving. Inform the DVLA about your condition if you intend to continue driving, especially if you experience double vision. This legal requirement involves contacting your ophthalmologist for a report, stating that you are being treated and therefore declared fit to drive.