Wednesday, February 28, 2024

Thyroid Eye Disease Hashimoto’s

Balancing Blood Sugar By Limiting The Intake Of Carbohydrates

Thyroid Eye Disease | Hashimotos | My Story

You might be surprised to learn that, while protein, fat, and micronutrients are all required by the human body, carbohydrates are not a required nutrient. While fat is required for normal cell function, we can actually survive on little to no carbohydrates in our diets.

Not only are carbs not required, theyre also the greatest contributor to blood sugar imbalances which some 50 percent of those with Hashimotos may have! These imbalances can contribute to anxiety, weight gain, hair loss, irritability, weakened adrenals, fatigue, and increased thyroid antibodies. Limiting ones carbohydrate intake and consuming plenty of good fats and proteins instead, can help balance blood sugar.

I recommend staying away from processed carbohydrates, as those will cause the greatest blood sugar swings. Stick to natural carbohydrates, such as sweet potatoes and berries, but not too many at first. For best results, you may want to limit yourself to one to two servings of carbohydrates a day if youre still in the early stages of your healing journey and are struggling with blood sugar swings.

For some of my clients, even too much fruit can throw them off. You will be able to improve your tolerance to carbohydrates as you heal.

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At Home Thyroid Blood Test

Over-the-counter medication

Sooth and treat dry eyes with artificial tears. Eye drops work by merely providing moisture to your eyes. You can find drops in preservative and non-preservative forms, and both tend to work well. You may want to avoid eye drops that also claim to reduce redness, as these drops can constrict blood vessels in your eyes and cause further irritation.

Ointments can also relieve dry eye, although they may blur your vision. Therefore, it is best to use these at night.

Prescription medication

Your ophthalmologist may prescribe oral medication or eye drops that primarily target inflammation. Swelling around the eyes prevents your tear ducts from releasing moisture into your eye. Some prescriptive medications may include antibiotics that also have an anti-inflammatory effect.

Eye inserts

Your ophthalmologist may recommend you install small clear tubes of medication between your lower eyelid and eye. These dissolvable daily inserts resemble a tiny grain of rice that releases medication to moisten the eye throughout the day.

Natural and alternative remedies

A warm, wet compress can do wonders for your eyes. Similarly, massaging your eyes gently can help stimulate your tear ducts. Some people find castor oil drops to be beneficial in relieving dry eye. As with adding any natural remedy, consult your ophthalmologist. Acupuncture may relieve dry eyes by reducing inflammation around the eye, and thus relieving eye irritation.

Treatment For Hashimotos Disease

With treatment, the outlook for most people with Hashimotos disease is excellent. Treatment usually includes medication with the synthetic thyroid hormone . The doctor will recommend regular blood tests to monitor your thyroid hormone levels to ensure they are within the recommended range.You will need to take the medication for life. Medication does not cure the condition, but helps maintain normal thyroid hormone levels. The symptoms will return if thyroid medication is stopped. Surgery may be required if the enlarged gland causes pressure symptoms.

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The Root Cause Autoimmune Diet

If you are still experiencing symptoms, especially gut-related symptoms, after following the two diets above, my recommendation is to step up to an advanced diet, like the Root Cause Autoimmune diet, or the Autoimmune Paleo diet.

While the Paleo diet has helped some people with Hashimotos feel much better, I have found that the AIP diet can be even more helpful, based on 75 percent of my readers and clients reporting significant symptom reduction and almost 40 percent seeing a reduction in thyroid antibodies!

Pearls And Other Issues

Things You Should Know about Hashimoto

A high index of suspicion is essential for patients with the classic symptoms of thyroid eye disease, with no history of thyroid disorders or a euthyroid status at presentation. An endocrine workup and orbital imaging are essential for a definite diagnosis in the absence of classical clinical presentation.

The management includes strict maintenance of euthyroid status, cessation of smoking, adequate lubrication, adequate control of the IOP, and monitoring of disease progression as per the CAS / VISA scoring systems at regular follow-ups. Any sign of progression to active disease or sight-threatening disease warrants urgent management.

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Use Stress Relief Techniques

Stress is a leading contributor to an underactive thyroid. Relieving stress can lead to a normal balance in your hormone levels. If your thyroid is normalized, your metabolism will speed up again.

And outside of hypothyroidism, stress has been linked to obesity in general. This is primarily due to exposure to excessive amounts of cortisol over time.

Here are some practical ways to relieve stress:

  • Sleep. A full 8 hours of high-quality sleep is essential for stress relief.
  • Turn off technology before bed. Cutting out blue light exposure an hour before bedtime can improve your sleep quality. You can do this by using software that blocks blue light, like f.lux and iristech.
  • Use blue light blocking glasses. We also encourage everyone to use blue-light blocking glasses after sunset if using any electronic devices, which helps to reduce cortisol production. Use code PRIMEHEALTH for 10% off of our favorite blue light blocking glasses at Ra Optics.
  • Meditate. Practicing meditation is another way to alleviate your stress and decrease excessive cortisol production.
  • Go outside. Spending time outdoors, especially in primarily green locations, can lower your stress and cortisol levels.

Reducing your stress levels is one of the best ways to lose weight with hypothyroidism without medication.

Hashimoto Diet Plan To Lose Weight

Hashimoto Diet Plan To Lose Weight is recommended for people who have been diagnosed with Hashimotos Thyroiditis. This diet was created by Dr. Izabella Wentz for patients with Hashimotos Thyroiditis, a condition that affects 10 million people in America alone.

If you have been diagnosed with Hashimoto disease or you suffer from hypothyroidism and are looking for an effective weight loss diet plan, its important to understand how Hashimoto disease affects your body chemistry.

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Cyanotoxins And Thyroid Function

Cyanotoxins are a diverse group of toxins produced by cyanobacteria. Their amount increases exponentially during cyanobacteria bloom in sweet or salt waters. In this case, their poisonous substances achieve high concentrations that are sufficient to harm or even kill animals and humans . Cyanotoxins microcystins, CYN, and lipopolysaccharides were linked to gastrointestinal complaints and effects on the immune system, including gastrointestinal inflammation . Microcystin significantly alters the mouse gut microbiome and induces dysbiosis . Microcystins are potent and specific inhibitors of protein phosphatases 1 and 2 A and can induce oxidative stress . CYN can also lead to oxidative stress, either directly or indirectly linked to the reduction of glutathione formation . Furthermore, CYN may reduce the viability of human gastrointestinal epithelial cells in culture and increases the permeability of intestinal epithelium . Cyanotoxins are also shown to facilitate the absorption of other toxins due to their inflammatory action on the gastrointestinal border .

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Deficits Of Vitamin D And Melatonin Linked To Autoimmune Predisposition

Thyroid Eye Disease vs. Graves’ Disease vs. Hashimoto’s Disease

Vitamin D deficiency has been especially demonstrated in TH patients. This may be due to the insufficiency of its natural effects on multiple immune cell-type differentiation and maturation, antigen presentation, as well as regulation of the production of cytokines and chemokines. In monocytes/macrophages, vitamin D has been shown to inhibit the expression of Toll-like receptor 2/4 and the production of inflammatory cytokines such as IL-1, IL-6, and TNF-. Therefore, vitamin D deficiency plays a crucial pathogenic role in autoimmune diseases .

Deficiency in vitamin D synthesis has been linked to autoimmune disorders associated with significant sex differences due to genetic, epigenetic, hormonal, and environmental factors . It is well-established that estrogens exert dose-dependent effects on the immune response by shifting T-cell subsets to a Th1 or a Th2 profile . The synthesis of estrogens and their varying concentrations during different phases related to reproductive function in women have long been associated with increased immune protection in females. In addition, estrogens have been shown to improve the function of vitamin D by promoting the expression of vitamin D receptors. These differences related to gender genetics and the associated hormonal background are an interesting direction for the development of individualized therapeutic approaches to autoimmune diseases .

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Can Levothyroxine Cause Dry Eye

Levothyroxine is a medication thats often prescribed to treat hypothyroidism. Common side effects include:

  • trouble sleeping

Some people also report eye pain, but this is rare.

Dry eye isnt a reported side effect of levothyroxine. However, if you notice dry eye while taking levothyroxine, its a good idea to mention it to your doctor or a healthcare professional.

Presence Of Dry Eye In Patients With Hashimotos Thyroiditis

Emrah Kan


Purpose. To evaluate the tear function tests in patients with Hashimotos thyroiditis and to compare the results with healthy subjects. Methods. A hundred and ten patients with Hashimotos thyroiditis and 100 healthy subjects were included in this study. The presence of thyroid-associated ophthalmopathy and tear function tests were evaluated clinically. The results were first compared between the patients and the control groups and then compared between patients with NOSPECS and patients without NOSPECS. Logistic regression analyses of the risk factors for dry eye including sex, gender, free plasma thyroxine, proptosis, upper eyelid margin-reflex distance, and duration of the disease were also evaluated. Results. The mean ocular surface disease index score was significantly higher and mean Schirmer and mean tear break-up time scores were significantly lower in patients compared to control subjects. Mean Schirmer and tear break-up time scores were found to be significantly lower in patients with NOSPECS when compared to the patients without NOSPECS. Both proptosis and free plasma thyroxine levels were significantly associated with dry eye. . Patients with Hashimotos thyroiditis tend to develop dry eye more common than healthy subjects. Proptosis and lower free plasma thyroxine levels were found to be risk factors for the presence of dry eye.

1. Introduction

2. Subjects and Methods

2.1. The OSDI Questionnaire
2.2. Schirmer Tear Test

3. Results

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What Are The Symptoms Of Hashimoto’s Thyroiditis

There are no signs or symptoms that are unique to Hashimotos thyroiditis.

Because the condition usually progresses very slowly over many years, people with Hashimotos thyroiditis may not have any symptoms early on, even when the characteristic thyroid peroxidase antibodies are detected in blood tests. TPO is an enzyme that plays a role in the production of thyroid hormones. If Hashimotos thyroiditis causes cell damage leading to low thyroid hormone levels, patients will eventually develop symptoms of hypothyroidism . Hypothyroid symptoms may include fatigue, weight gain, constipation, increased sensitivity to cold, dry skin, depression, muscle aches and reduced exercise tolerance, and irregular or heavy menses. In some cases, the inflammation causes the thyroid to become enlarged , which rarely may cause neck discomfort or difficulty swallowing.

Fact: You Can Develop Ted Without Having Graves Disease


While its true that many people are diagnosed with Graves before being diagnosed with Thyroid Eye Disease , its not always the case. In fact, about 1 in 10 people with TED develop it without having Graves disease.

Its also not uncommon for people to be diagnosed with TED before, during, or even after getting diagnosed with Graves disease.

People diagnosed with TED may also be diagnosed with a different type of thyroid condition called Hashimotos disease or Hashimotos hypothyroidism .

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Top 4 Things To Know #: Both Are Autoimmune Diseases But Very Different

As mentioned above, these two autoimmune thyroid conditions are very common with respect to causing thyroid dysfunction. Hashimotos thyroiditis is an autoimmune disease where the immune system malfunctions and self- antibodies attack ones own thyroid tissue as if it was foreign. We do not know exactly why it occurs, but we think multiple factors may play a role. Excessive iodine may trigger thyroid disease. There is likely a hormonal component because women are affected much more commonly than men. Lastly, there is likely a genetic factor as well because Hashimotos thyroiditis is seen in families where multiple people have thyroid disease or autoimmune disease.

Hashimotos disease involves your immune system causing inflammation and scarring in the thyroid gland. This process is often cyclical and causes repeated damage to the thyroid gland itself . This ultimately leads to decreased thyroid hormone production and subsequent symptoms. Common symptoms include fatigue, weight gain, memory problems or brain fog, depression, neck/thyroid discomfort, thinning hair or hair loss, heat/cold intolerance, skin and nail changes, joint and muscle pain, constipation, difficulty sleeping, and changes in appetite.

Figure 1: Hashimotos disease on ultrasound. Note the irregular, moth-eaten, scalloped appearance of the thyroid tissue outlined in orange.

Figure 2: Normal thyroid tissue on ultrasound

Figure 3: Numerous symptoms of Graves Disease

Treatment Of Hashimotos Thyroiditis

Most people with Hashimotos need treatment. However, if your thyroid is functioning normally, your doctor may monitor you for changes.

If your thyroid isnt producing enough hormones, you need medication. Levothyroxine is a synthetic hormone that replaces the missing thyroid hormone thyroxine . It has virtually no side effects. If you need this drug, youll likely be on it for the rest of your life.

Regular use of levothyroxine can return your thyroid hormone levels to normal. When this happens, your symptoms will usually disappear. However, youll probably need regular tests to monitor your hormone levels. This allows your doctor to adjust your dose as necessary.

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Can Hashimoto’s Thyroiditis Cause Thyroid Eye Disease

In rare cases, yes. While it’s more common for those with Graves’ disease to develop the condition, around 6% of those with Hashimoto’s disease develop thyroid eye disease.

Hashimoto’s thyroiditis, also known as Hashimoto’s disease, is another autoimmune disease affecting the thyroid gland. Unlike Graves’ disease, which causes hyperthyroidism, Hashimoto’s thyroiditis causes hypothyroidism as your immune system attacks the thyroid gland itself.

Eventually, your body destroys parts of the thyroid gland permanently. This can take months or years to happen, but over time, the thyroid gland becomes unable to create enough thyroid hormone due to the damage done by the bodys immune system.

The lack of thyroid hormone in the body is called hypothyroidism.

  • Slow heart rate

  • Increased cold sensitivity

You are at higher risk of developing thyroid eye disease if you smoke, are older, and have had Hashimoto’s disease for a long time.

The most common Hashimoto-induced thyroid eye disease symptom is dry eyes. Your tear ducts rely on hormones from the thyroid gland to produce lubrication for your eyes. Along with dry eyes, you might experience:

  • Eyelids that swell or don’t close completely

  • Eyelashes and eyebrow hairs that fall out

Thyroid eye disease is a temporary condition with an active phase that lasts up to two years. After that, most of the symptoms will disappear, but it may cause long-term effects such as double vision.

What Are The Longer

How My Hashimoto’s Disease Affects My Appearance (Hypothyroid Symptoms) | Skincare with @Susan Yara

With the correct treatment, thyroid eye disease can be well managed and patients can live full and active lives. Most of the effects of the thyroid eye disease will settle with time and when thyroid function is stabilised. Patients taking carbimazole tablets to treat hyperthyroidism may need to take them daily for life, although definitive treatment of the overactive thyroid gland with radioiodine or surgery is generally preferred, once the eye disease has settled down. Regular blood tests should be carried out to monitor thyroid hormone levels and the dose of carbimazole adjusted accordingly. However, there are other treatment options such as thyroidectomy or radioiodine treatment that can be considered once the eye disease has settled down.

The changes in the physical appearance of the eyes can have a psychological effect on the individual, causing low self-esteem. The long-term consequences of the disease, even after the thyroid has settled down, may be difficult to accept. Some patients may have a permanent change to their appearance, which may require surgery. Very rarely, there is a permanent loss of vision this can happen if the disease is left untreated at the sight-threatening stage.

Patients should stop smoking as this is known to aggravate the condition. Sunglasses may be necessary even when indoors. If double vision is not corrected, driving will be dangerous. Patients should discuss any concerns with their doctor.

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Postoperative And Rehabilitation Care

Cosmetic rehabilitation is essential in TED management. Asymmetrical proptosis is common during inactive disease. A graded surgical orbital decompression helps achieve a cosmetically symmetrical look.

The surgical plan is customized depending on the amount of proptosis correction, the pattern of strabismus, and the orbital anatomy. The restricted EOM is recessed to achieve orthophoria in the primary gaze. The final correction for the lid retraction is planned at least six months after the strabismus surgery. Blepharotomy, blepahromyotomy, levator recession, and spacer grafts are the common strategies for lid retraction correction.

Enhancing Healthcare Team Outcomes

Thyroid eye disease cases require a multi-specialty effort for early diagnosis and timely management. Physicians and endocrinologists are the primary contacts for thyroid disorder cases. All predisposed patients should undergo regular eye checkups. Long-term sustenance of euthyroid status is the foremost pillar for TED prevention.

Appropriate control of smoking and nicotine addiction is necessary with the involvement of psychiatrists, de-addiction clinics, anonymous support groups, counseling, and patient deterrence. The sight-threatening disease and cosmetic disfigurement are also a source of anxiety for the patients. Trained professionals are necessary to deal with psychosocial issues.

Ophthalmologists and oculoplastic personnel play an essential role in the long-term follow-up, medical, and surgical management of TED cases. Visual and cosmetic rehabilitation are important end-points of TED management.

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