Causes Of Thyroid Eye Disease

Coping With Changes To Your Appearance

It is well known that TED can affect your psychological and social well-being. You may feel anger, loss of self-esteem or confidence, or socially isolated, because of the change in the appearance of your eyes. Your mood can also be affected by medications you may be taking, such as steroids. TED can change your facial appearance and alter your expression which may affect the way people react to you which, understandably, can be difficult to cope with. Treatment, which may include surgery, can often improve this and counselling, or contact with others who have TED, can help you find coping strategies.

Some of the following organisations might be helpful:

• Thyroid Eye Disease Charitable Trust can help put you in touch with other people who have had similar experiences which is often helpful.
• The British Thyroid Foundation has a network of telephone support volunteers that can help. They also have closed Facebook groups for people with TED. You can email them at if you would like their support.
• The charity Changing Faces also offers a support service for anyone experiencing a condition or injury that affects their appearance.
• Our Counselling and Wellbeing team can offer telephone counselling to anyone affected by sight loss or an eye condition.

Page last reviewed: Sept. 1, 2022

Next review due: Jan. 31, 2023

Who Is Affected By Thyroid Disease

Thyroid disease can affect anyone men, women, infants, teenagers and the elderly. It can be present at birth and it can develop as you age .

Thyroid disease is very common, with an estimated 20 million people in the Unites States having some type of thyroid disorder. A woman is about five to eight times more likely to be diagnosed with a thyroid condition than a man.

You may be at a higher risk of developing a thyroid disease if you:

• Have a family history of thyroid disease.
• Have a medical condition .
• Take a medication thats high in iodine .
• Are older than 60, especially in women.
• Have had treatment for a past thyroid condition or cancer .

What Common Symptoms Can Happen With Thyroid Disease

There are a variety of symptoms you could experience if you have a thyroid disease. Unfortunately, symptoms of a thyroid condition are often very similar to the signs of other medical conditions and stages of life. This can make it difficult to know if your symptoms are related to a thyroid issue or something else entirely.

For the most part, the symptoms of thyroid disease can be divided into two groups those related to having too much thyroid hormone and those related to having too little thyroid hormone .

Symptoms of an overactive thyroid can include:

• Experiencing anxiety, irritability and nervousness.
• Having trouble sleeping.

• Experiencing an intolerance to cold temperatures.

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What Can I Do To Feel Better Right Now

• For eye issues associated with TED, you can apply cold compresses to your eyes to combat swelling and inflammation, wear sunglasses to reduce light sensitivity, use lubricating eyedrops or gel to increase moisture, and elevate the head of your bed to relieve eye pressure from fluid buildup.

• Over-the-counter creams or ointments with hydrocortisone can help soothe swelling or reddening skin.

Causes Of Thyroid Eye Disease

Doctors do not fully understand what causes TED. Some patients may have a genetic predisposition to developing it. That doesn’t mean they will develop the disease, but they may if the gene gets triggered by other factors.

Several factors are linked with a higher risk of developing TED:

• Certain health conditions Patients with conditions such as Graves disease, type 1 diabetes or rheumatoid arthritis may be more likely to develop TED.

• Family history Patients who have a family member with TED or another autoimmune disease may be more likely to develop it.

• Smoking Patients who smoke have a higher risk of developing this disease than non-smokers.

• Radioactive iodine therapy This common treatment for hyperthyroidism increases the risk of developing TED.

Women also are more likely than men to be diagnosed with thyroid eye disease, and they make up 86% of all cases, according to the American Academy of Ophthalmology . TED occurs most commonly in middle-aged women.

As reported in the Review of Ophthalmology, about 80% of patients who develop the condition have an overactive thyroid that produces too much thyroid hormone, such as with Graves disease. But about 10% of patients have an underactive thyroid that produces too little thyroid hormone. And up to 10% of patients may have normal thyroid function and no diagnosed thyroid disease.

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When To See A Healthcare Provider Or Go To The Hospital

If you have symptoms that could indicate thyroid eye disease, you should talk to a medical professional as soon as possible. Early diagnosis can lead to faster treatments that may help you avoid some of the potential complications of the disease.

Even if you have already received a thyroid eye disease diagnosis, you should notify your healthcare provider of any changes in symptoms. It is important to keep monitoring your condition, so your practitioner can adjust treatments.

In general, you should notify your healthcare provider if you notice any changes in the appearance of your eyes or have problems seeing.

Other Types Of Treatment

If you develop double vision , you may be referred to a specialist health professional who manages problems with eye muscles . They may give you modified glasses that block off vision from one eye or put a special cover, called a prism, over one side to stop the diplopia.

Treatment using radiation may be used in some places on some people. The aim is to reduce the swelling in the eye. It is used alongside other forms of treatment.

A number of new treatments are being investigated.

Your doctors will also treat any abnormality of thyroid function with antithyroid medicines. This is usually with tablets but may also include radioactive iodine or, uncommonly, surgery to the thyroid gland. We know that good control of the thyroid function helps lessen the severity of thyroid eye disease. See the separate leaflet called Antithyroid Medicines.

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Thyroid Eye Disease Center

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The eye changes associated with thyroid disease are referred to as Thyroid Eye Disease . Your doctor may also use the term Thyroid Associated Orbitopathy . Although TED is seen in all types of thyroid disorders, it is most common in patients that are or were hyperthyroid. It also rarely occurs in those who are hypothyroid and even when there is an absence of thyroid abnormalities in the body.

Thyroid disease can cause multiple eye problems. These include redness and swelling, double vision, decreased vision, eyelid retraction , and a bulging of the eye itself. It is important to realize that if one of these occurs, it does not mean you will necessarily get all the other symptoms too.

Eye problems will usually occur and frequently change in type or severity for between six months and two years. Once stabilized, it is unusual for the eyes to start changing again. Some patients are left with permanent changes, and in others the eyes return to normal. A great deal can be done to improve these conditions with medical treatment, although some patients will need surgery to help ease their issues.

Other Thyroid Disorders After Covid

Table Table55 summarizes the main characteristics of 12 cases who expressed focal painful thyroiditis, silent thyroiditis, concurrent GD and SAT, thyroid eye disease, overt hypothyroidism, atypical subacute thyroiditis, and painless thyroiditis with thyrotoxic periodic paralysis after COVID-19 vaccination. Focal painful thyroiditis was reported in 3 women with a median age of 38.0 years after vaccination with the Pfizer vaccine. Painless or silent thyroiditis is caused by the destruction of thyroid follicles by inflammation, which results in the release of preformed T3 and T4, causing transitory thyrotoxicosis. Patients display thyrotoxicosis symptoms, but unlike the SAT, they have no pain or tenderness in their thyroid. In 212 weeks, the thyrotoxic status recovers spontaneously, and the patients either return to euthyroid condition or pass through a temporary hypothyroid stage . Moreover, 3 patients with a median age of 32.0 years exhibited silent thyroiditis after receiving the first dose of the mRNA-based vaccines . Two patients also displayed concurrent GD and SAT after receiving the first dose of the Pfizer or Janssen vaccines.

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Fact: If You Have Ted You Should See An Ophthalmologist Who Has Experience Treating Ted

Thyroid Eye Disease is a unique and rare eye condition, and not all doctors are used to treating it. Thats why its important that you see a doctor who has the right experiencea TED Specialist.

TED Specialists are ophthalmologists who usually have advanced training, such as oculoplastic surgeons, neuro- ophthalmologists, and strabismus surgeons.

While there are about 20,000 eye doctors in the US, most are not used to seeing TED patients. TED Specialists have advanced training in specific types of eye and vision care.

How Can Ted Be Managed During The Active Stage

During the active stage of TED, treatments are aimed at improving your symptoms and protecting your eyes while the active stage of the condition runs its course. Symptoms can fluctuate during the active stage which can last months or a couple of years.

Most commonly, during the active stage, treatment involves treating dry eyes or double vision. Symptoms of dry eye can be managed with artificial tear eye drops, and double vision may be managed with prisms or occlusion . For most people, this is all the treatment they will need at this stage and the condition wont get any more advanced than this.

Much less commonly, where your vision is at risk, your ophthalmologist may recommend immunosuppressant treatment, usually steroids, to help reduce the inflammation. Orbital radiotherapy treatment may also be considered to treat the tissues around the eyeball and prevent optic nerve damage. The earlier these treatments can be given, the more they can help prevent the condition from progressing and protect your sight. In very severe cases, emergency orbital decompression surgery may be needed this operation involves removing some of the bone and/or fat in your eye socket to provide more room for the swollen muscles, and to take the pressure off the optic nerve. All these treatments aim to avoid permanent damage to your optic nerve. Very few people have TED that progresses to a stage where these treatments are needed.

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Dry Eye Or Excessive Tearing

Inflammation can also lead to a range of eye issues, including dry eye, which can feel as if theyre constantly gritty. Artificial tears can help restore lubrication, says Kossler. Paradoxically, dryness can also cause watery eyes, because the body ramps up tear production to combat the irritation, according to the Mayo Clinic.

How Long Does It Take To Recover From Thyroid Surgery

It will take your body a few weeks to recover after your thyroid is surgically removed . During this time you should avoid a few things, including:

• Submerging your incision under water.
• Lifting an object thats heavier than 15 pounds.
• Doing more than light exercise.

This generally lasts for about two weeks. After that, you can return to your normal activities.

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What Causes Thyroid Disease

The two main types of thyroid disease are hypothyroidism and hyperthyroidism. Both conditions can be caused by other diseases that impact the way the thyroid gland works.

Conditions that can cause hypothyroidism include:

• Thyroiditis: This condition is an inflammation of the thyroid gland. Thyroiditis can lower the amount of hormones your thyroid produces.
• Hashimotos thyroiditis: A painless disease, Hashimotos thyroiditis is an autoimmune condition where the bodys cells attack and damage the thyroid. This is an inherited condition.
• Postpartum thyroiditis: This condition occurs in 5% to 9% of women after childbirth. Its usually a temporary condition.
• Iodine deficiency: Iodine is used by the thyroid to produce hormones. An iodine deficiency is an issue that affects several million people around the world..
• A non-functioning thyroid gland: Sometimes, the thyroid gland doesnt work correctly from birth. This affects about 1 in 4,000 newborns. If left untreated, the child could have both physical and mental issues in the future. All newborns are given a screening blood test in the hospital to check their thyroid function.

Conditions that can cause hyperthyroidism include:

What Causes Graves Ophthalmopathy

The exact cause of GO isnt clear, but it may be a combination of genetic and environmental factors.

The inflammation around the eye is due to an autoimmune response. With GO, the same abnormal immune response that triggers the thyroid gland in Graves disease affects the muscles and soft tissues around the eye. This leads your body to produce an inflammatory response.

Symptoms develop because of swelling around the eye, forward bulging of the eyes, and retraction of the eyelids.

Graves eye disease usually occurs in conjunction with hyperthyroidism, but not always. It can occur even when your thyroid isnt currently overactive.

Risk factors for GO include:

• genetic influences
• iodine therapy for hyperthyroidism

Women are also at a higher risk of developing GO compared with men.

Theres no way to completely prevent Graves disease or Graves eye disease. But if you have Graves disease and you smoke, youre around 5 times more likely to develop eye disease than people who dont smoke. Plus, eye disease tends to be more severe for those who smoke.

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The Thyroid Gland And Important Terms

Thyroid Gland: The thyroid gland is located in the front of your neck. It produces thyroid hormones that are sent to the blood and carried around to other parts of your body. These hormones help your body use energy, stay warm and keep the brain, heart, muscles, and other organs working normally. The thyroid gland can become overactive or underactive . This is most often due to an autoimmune disease in your body.

Hyperthyroidism: Hyperthyroidism is a condition where the thyroid gland is stimulated by the immune system to produce more thyroid hormones than are needed by the body. Symptoms may include weight loss, nervousness, irritability, increased perspiration, fast heart rate, hand tremors, difficulty sleeping, thinning of the skin, brittle hair, and frequent bowel movements.

Hypothyroidism: Hypothyroidism is a condition where thyroid gland function is blocked by the immune system and not enough thyroid hormone is produced for the bodys needs. Symptoms may include feeling cold and tired, having drier skin, becoming forgetful and depressed, and having constipation.

Autoimmune disease: If you have an autoimmune disease, your immune system mistakenly attacks your body. Autoimmune diseases can affect many parts of the body. The cause of autoimmune diseases is largely unknown.

The Thyroid Gland

Surgery For Thyroid Eye Disease

Surgery is sometimes used to treat moderate to severe cases. Surgery usually is done during the inactive phase of the disease for cosmetic reasons and to treat symptoms such as double vision.

Not all patients will require all types of surgery. Types of surgery may include:

• Orbital decompression surgery This type of surgery involves removing fat around the eye and possibly removing bone around the eye socket to allow the eye to sit further back. Orbital decompression surgery can reduce eye-bulging and prevent vision loss caused by pressure on the optic nerve.

• Strabismus surgery This surgery involves releasing tight muscles that result in misalignment of the eyes.

• Eyelid surgeryEyelid surgery may correct the retracted eyelids that occur in some patients.

• Cosmetic surgery or procedures Some patients seek surgery or other cosmetic procedures for fat deposits or undereye bags that result from TED. Instead of surgery, a doctor may be able to use botulinum toxin injections or fillers to fix these issues.

Thyroid eye disease may affect patients psychologically due to eye symptoms, vision loss or changes in appearance. For these reasons, patients may need to see a psychologist or other mental health professional for treatment for depression or anxiety related to the condition.

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How Is Graves Ophthalmopathy Diagnosed

When you already know you have Graves disease, a doctor can make a diagnosis of GO after examining your eyes. A specialized doctor called an ophthalmologist will help you manage GO, while your primary care doctor or endocrinologist will manage hormone treatment for Graves disease.

If you dont already have a diagnosis of Graves disease, your doctor will likely begin by looking closely at your eyes and checking your neck to see whether your thyroid is enlarged.

Then, your blood can be checked for thyroid stimulating hormone . TSH, a hormone produced in the pituitary gland, stimulates the thyroid to produce hormones. If you have Graves disease, your TSH level will be low, but youll have high levels of thyroid hormones.

Your blood can also be tested for Graves antibodies. This test isnt needed to make the diagnosis, but it may be done anyway. If it turns out to be negative, your doctor can start looking for another diagnosis.

Imaging tests such as ultrasound, CT scan, or MRI might also be done so the doctor can get a detailed look at the thyroid gland.

Your doctor may also want to perform a procedure called radioactive iodine uptake. For this test, youll take some radioactive iodine and allow your body to absorb it. Later, a special scanning camera can help determine how well your thyroid takes in iodine, which helps inform the diagnosis of Graves disease.

There are quite a few things you can try on your own to ease symptoms of GO, including:

What Are The Treatments For Thyroid Eye Disease

There are three main ways to treat the double vision that is caused by Thyroid Eye Disease. Prisms can be used with eyeglasses to try to reduce double vision. Patching one eye will eliminate double vision, but this is not a satisfactory solution for many patients. Finally, misalignment of the eyes can often be improved with surgery. In order to maximize the chance that surgery will successfully realign the eyes, typically the doctor will recommend waiting until the amount of misalignment has remained stable for approximately six months.

It is important to use lubricating eye drops and ointments to prevent dryness and injury to the surface of the eye. Other medications have limited benefits in treating Thyroid Eye Disease. One clinical study found that selenium improved many symptoms when the condition is mild. Corticosteroids can occasionally improve eye movements. However, for most patients there are no convincing long-term benefits from this medication.

When necessary, an additional operation can be performed to relieve severe eye bulging by making more space in the orbit. In addition, surgery can be done to correct the position of the eyelid, which is an important aspect of keeping the eye properly lubricated. Radiation therapy is used when sight is threatened in severe cases of Thyroid Eye Disease. Visual loss can occur when the optic nerve is compressed by swollen, thickened eye muscles.

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