Thyroid Eye Disease Symptoms Vary
TED symptoms can vary, and they may come and go, but Marx lists these as a few of the most common:
- Eyelid retractionHappens when muscles surrounding the eye swell and push the eye forward, pulling upper and lower eyelids back.
- Eye protrusionSwelling may push the eye forward and make the patient look like they are staring.
- Dry eyeWhen the eyes retract or protrude, theyre exposed to dust and wind. This can cause dryness and an uncomfortable, scratchy feeling. It may also cause blurry vision and light sensitivity.
- Vision changesSwelling around the eye may cause double vision. It can also put pressure on the optic nerve, which connects the eye to the brain.
- Eye bagsSwelling can cause the tissue around the eye to bulge, commonly called bags around the eyes.
Fortunately, we can treat all of these symptoms, and some new drugs are helping to make a real difference for some patients. But the treatments can vary as much as the symptoms, says Marx. Because TED diagnoses and symptoms tend toward the complex, patients need to work closely with their ophthalmologists and thyroid specialists to find the best, customized treatments.
Thyroid Glands Relation To The Eye
Although Graves’ disease and Graves’ eye disease both stem from the immune systems attack on healthy tissue, one disease does not directly cause the other. Thats why treatment of the thyroid gland, while important, does not improve the eye disease. The two diseases run their separate courses and do not necessarily occur at the same time.
What Causes Dry Eye
There are a few ways Thyroid Eye Disease can cause dry eye.
The muscles in the eyelids can tighten, causing the upper and lower lids to pull back. As a result, it may be harder to close the eyes, leaving them more likely to feel dry or irritated. Eye bulging can also prevent eyelids from closing completely. This leaves the clear, protective layer over the front of the eye exposed. See before and after photos of how TEPEZZA treats eye bulging.
During acute TED, tear ducts may become inflamed , which can also cause dryness. Learn more about Thyroid Eye Disease symptoms.
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What Is Thyroid Eye Disease
Thyroid eye disease is an eye disorder that causes inflammation and damage to the tissues around the eye, including muscles, fatty tissue and connective tissue. TED is an autoimmune condition, or one that happens because your protective immune system attacks your body.
There are two phases of TED: the active or inflammatory phase and the stable phase. The active phase can last for months up to three years, while the stable phase follows when the inflammation stops.
TED is often related to Graves disease, which is also an autoimmune disease. It can affect the thyroid, eyes and skin.
Graves disease can cause hyperthyroidism, which means that your body releases too many thyroid hormones. Less commonly, Graves disease can also cause hypothyroidism, which means that your body doesnt release enough hormones. Both can result in thyroid eye disease, but people with low levels of thyroid hormone who do have eye swelling and eyebrow hair loss tend to have severe cases of hypothyroidism.
However, thyroid eye disease can happen in people with normal levels of thyroid hormones. Thyroid conditions can also cause secondary glaucoma because of the damage to the optic nerve.
Who does thyroid eye disease affect?
The median age for being diagnosed with TED is 43 years old. However, you can be diagnosed much earlier or much later than 43.
You may be more likely to develop thyroid eye disease if you:
Symptoms Of Thyroid Eye Disease
Early symptoms of thyroid eye disease may include:
- Itching, dry eyes, and difficulty wearing contact lenses
- Excessively watery eyes
- Red or bloodshot eyes
- Swelling of the orbital tissues which causes the eye to be pushed forward referred to as exophthalmos, which can make people with thyroid eye disease appear to have a wide-eyed or bulging, protuberant stare.
- Pain when moving the eyes up, down, or sideways
- Light sensitivity
Thyroid eye disease can cause inflammation and swelling that may affect the eyes as well as the muscles and other tissues around the eyes. As the disease progresses, symptoms can include the following:
- Increased sensitivity to light
- Impaired vision
- Difficulty moving or closing the eyes
Thyroid eye disease is known to go through varying degrees of severity and can go into periods of remission. It often lasts six months to two years. When it has been inactive for a period of around a half a year, it’s less likely to recur.
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How To Treat Graves Eye Disease
If you have this condition, treatments are available. However, treatment plans will depend on disease severity and individual cases.
Your doctor may prescribe the use of corticosteroid medication, immunosuppressants, radiation therapy, thyroid surgery, or eye surgery. To provide pain relief from symptoms, your doctor may also recommend medicated eye drops and non-steroidal anti-inflammatory drugs like aspirin, naproxen, or ibuprofen.
Finally, if you develop Graves orbitopathy, your doctor may prescribe glucocorticoids as first-line treatment. However, this medication does have strong side effects.
Also, the novel drug teprotumumab may be an option considered by your eye care specialist. This medication could manage the ocular condition.
Clinicians may recommend simple yet effective medical management strategies, including smoking cessation or selenium supplement use, to decrease disease severity.
Problems Associated With Thyroid Eye Disease
Dry irritated eyes
TED may cause you to experience dry, irritated and often teary eyes. This is usually due to the eyelids retracting and or protruding. When the eyelids do not close completely at night, the cornea dries out and becomes quite uncomfortable. The use of lubricating ointment for the eye at night and artificial tears during the day can provide a great deal of relief. Do not be afraid to use the tears frequently, as much as every 1/2 to 1 hour if necessary.
Double vision
TED can cause swelling, irritation and scarring of the muscles that move the eyes. This can lead to double vision. Double vision may not be present all the time, sometimes it is noticeable only when looking in certain directions, while in other patients it is always present. Often the amount of double vision will change week to week. At times it can disappear completely without treatment. Once the double vision has been stable for at least several months, surgery can be performed to correct it if necessary. Your specialist will refer you to a specialist for the surgery.
Eyelid retraction
Eye protrusion
Vision loss
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What Are The Symptoms Of Thyroid Eye Disease
If you have Graves disease, eye symptoms most often begin within six months of disease diagnosis. Very rarely, eye problems may develop long after the Graves disease has been treated. In some patients with eye symptoms, hyperthyroidism never develops and, rarely, patients may have hypothyroidism. The severity of the eye symptoms is not related to the severity of the hyperthyroidism.
Symptoms of thyroid eye disease are caused by the tissues, fat, and muscles of the eye socket swelling and pushing the eyeball forward. It may be possible that symptoms may appear in one eye more than the other. The symptoms of thyroid eye disease include:
Dry, gritty and irritated eyes
Red eyes
Bulging eyes and lid retraction giving a staring or startled appearance
In more advanced thyroid eye disease, there may also be:
- Trouble moving eyes and closing eyes
- Inability to completely close your eye causing a corneal ulcer
- Colors appear to be dull or not as bright
- Blurred or loss of vision due to optic nerve compression or corneal damage
Double vision
Use And Important Safety Information
What is the most important information I should know about TEPEZZA?
Infusion reactions can happen during or within 24 hours after your infusion of TEPEZZA. If you have a reaction while receiving TEPEZZA, your doctor or nurse will slow or stop your infusion and treat your reaction. If you have a severe infusion reaction, your doctor may stop your treatment completely.
Tell your doctor or nurse right away if you have any of these symptoms during or after your treatment with TEPEZZA:
- High blood pressure
- Redness of the face/Feeling hot
- Difficulty breathing
If you have inflammatory bowel disease , such as Crohn’s disease or ulcerative colitis, TEPEZZA may make your IBD symptoms worse. Symptoms of worsening IBD may include: an increased number of loose stools with stomach pain or cramps, and blood in your stools. After each TEPEZZA infusion, tell your doctor right away if you have worsening IBD symptoms.
TEPEZZA may cause an increase in your blood sugar. Before starting treatment with TEPEZZA, tell your doctor if you are currently being treated for diabetes, know your blood sugar is high, or have been diagnosed with diabetes. It is important for you to take your treatments and follow an appropriate diet for glucose control as prescribed by your doctor.
Before receiving TEPEZZA, tell your doctor if you:
What are the possible side effects of TEPEZZA?
This is not a complete list of all possible side effects. Tell your doctor or treatment team about any side effect you may have.
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What Causes Graves Disease And Thyroid Eye Disease
Your immune system makes proteins called antibodies to protect you against germs. With Graves’ disease, your immune system makes antibodies that mistakenly attack your thyroid gland. This kind of condition is called an autoimmune disease.
These antibodies make your thyroid grow larger and produce too much of thyroid hormone. Thatâs called hyperthyroidism. The extra thyroid hormone can cause symptoms including weight loss, a fast heartbeat, high blood pressure, and moodiness.
Abnormal antibodies can also attack and damage the fat and muscles around your eyes. Your eyes may become red, swollen, and pushed forward . This is thyroid eye disease.
Graves’ disease sometimes runs in families. Having certain genes might increase your risk.
Smoking is another big risk factor. If you have Graves’ disease and you smoke, you’re twice as likely to get thyroid eye disease as someone who doesn’t smoke.
Treating Hypothyroidism In Dogs
Hypothyroidism is treatable. Your veterinarian will probably give your dog a prescription for thyroxine, a replacement hormone compound, to offset your dogs low thyroid function.
The dosage will vary depending on your dogs weight and thyroid levels. Your veterinarian may need to adjust your dogs dosage over time, and you should expect to see results after one to two months. Once your veterinarian has determined a stable dose, your dog will most likely need to have his thyroid levels retested once or twice a year and continue the stable dose of medication, for the rest of his life.
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Dry Blurry Eyes And Hypothyroidism
- Thyroid function and eye health
- Common eye symptoms in thyroid dysfunction
- Managing eye health with hypothyroidism
Eye problems are not commonly associated with hypothyroidism, an underactive thyroid. However, if you have Hashimoto’s thyroiditis, you may be at higher risk for eye disease. Hashimoto’s thyroiditis is an autoimmune condition that damages the thyroid gland. According to the American Thyroid Association, six-percent of people with Hashimoto’s have eye disease related to their thyroid functioning.
Eye conditions related to the thyroid are more common with Graves’ disease, an autoimmune condition causing hyperthyroidism than they are with Hashimoto’s. Indeed, one of the hallmark symptoms of Graves’ disease is bulging eyes. While thyroid-associated eye disease may get overlooked in people with Hashimoto’s, studies find that both hyper- and hypothyroid autoimmune processes can cause uncomfortable eye symptoms.
Thyroid Eye Disease Management
Thyroid eye disease is a self-limiting disease: if left untreated, the inflammation will gradually go by itself. However, the physical changes caused by the swelling may remain. This is because some of the tissues that have been stretched may not always return to their original form. The aim of treatment is mainly to limit inflammation and swelling occurring during the inflamed period and to protect the surface of the eye. There are also treatments for people whose tissues have not been able to return to their original form after the inflammation has settled.
Thyroid eye disease is managed by a specialist eye doctor and the underlying thyroid problem by your own doctor or by a a specialist in the hormone systems of the body .
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How Is Thyroid Eye Disease Different From Graves Disease
Thyroid Eye Disease and Graves disease are both autoimmune diseases. Normally, the immune system can tell the difference between your cells and foreign cells, like bacteria. But with an autoimmune disease, the immune system attacks healthy parts of your body by mistake.
With Graves disease, the immune system attacks the thyroid. In TED, the immune system attacks the muscle and fat tissue behind the eyes.
Because Graves disease and TED attack different parts of the body, they need different treatments. Treatment for Graves disease wont work for TED. TEPEZZA is the first and only FDA-approved treatment for TED. Plus, Graves disease and TED are usually treated by different doctors. Ophthalmologists who have advanced training usually treat TED, and endocrinologists usually treat Graves disease.
Get your questions about TED answered today. Call a Nurse Advocate at , Monday through Friday, 8AM to 8PM ET.
Commonly Used Terms For Thyroid Eye Disease
TED is a rare and unique condition, but is often considered part of a separate condition called Graves disease. Its important to remember that they are different diseases and require different medicines. Although they are separate from one another, TED is often called by different names containing the word Graves or thyroid, like:
- Graves eye disease
If you hear any of these terms, know that they mean Thyroid Eye Disease .
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There is no publicly available rating for this care provider for one of three reasons:
- Ophthalmology, Oculofacial Plastic Surgery and Ophthalmology Portland
Are There Any Complications From Thyroid Eye Disease
Most people do not develop permanent complications. However, where treatment is delayed or where the thyroid eye disease has been severe, there can be lasting effects. They are also more likely in older people, in those who smoke and in people with diabetes. Possible complications include:
Complications from the disease
- Damage to the clear window of the eye .
- Permanent squint or double vision .
- Damage to the nerve of the eye, resulting in poor vision or colour appreciation.
- Altered appearance .
Complications from treatment
- Side-effects from the immunosuppressive medicines.
- Side-effects from the surgery:
- New double vision .
- Loss of vision .
- There are some other very rare complications that your surgeon will talk you through.
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Who Is At Risk Of Developing Graves Ophthalmopathy
People who have Graves disease face a high risk of developing this ocular condition. Almost all cases of Graves ophthalmopathy will have Graves disease as the underlying health problem.
Similarly, people with hyperthyroidism or those receiving radioactive iodine treatment may be at risk.
Finally, cigarette smoking increases the risk of developing a severe form of this disease. Compared to non-smokers, smokers are less likely to respond well to immunosuppressive treatments given to manage the condition.
Investigators have established an association between smoking and other autoimmune diseases, such as rheumatoid arthritis and Crohn’s disease. This observation suggests that smoking may cause a generalized stimulation of autoimmune processes.
What Does Double Vision Look Like
While not all people with Thyroid Eye Disease will get double vision, those who do may have different types. Some people have double vision all the time . Other people may have double vision that comes and goes. “Temporary” and “situational” double vision can come and go, and are caused by TED. Watch the videos below to see how these different types of double vision may appear.
Temporary
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Diagnosing Hypothyroidism In Dogs
The Merck Veterinary Manual states that hypothyroidism is one of the most over-diagnosed diseases in dogs. This is because many diseases mimic hypothyroidism. Some conditions or clinical signs even improve with thyroid medication. Other diseases also affect the thyroid levels, but are not hypothyroidism. This can make diagnosing a thyroid condition tricky, so be patient as you work with your veterinarian to get to the root of your dogs symptoms.
Your veterinarian will diagnose your dog based on clinical signs and careful diagnostic testing. This will probably require several blood tests to determine if your dog exhibits any of the abnormalities commonly associated with the disease, and regular monitoring of your dogs thyroid levels.
One of these tests will probably be a test of your dogs T4 concentration. This is a good initial screening test for hypothyroidism, however, your veterinarian may recommend running further tests to get a definitive result.
Who Is At Risk For Thyroid Eye Disease
Thyroid eye disease is most commonly associated with Graves disease. It can also occur with normal thyroid hormone levels or low levels of thyroid hormones .
Other risk factors for thyroid eye disease include:
- Age: Usually affects middle-age adults but can occur at any age
- Gender: Females are affected more than males
- Family history of thyroid eye disease
- Smoking: Smoking increases the risk of thyroid eye disease by 78 times, causes thyroid eye disease to have a longer active phase, and it reduces the effectiveness of treatments
- Radioactive iodine therapy: Radioactive iodine has been used to treat hyperthyroidism and Graves disease. This treatment should be used with caution in people with active thyroid eye disease as it may worsen the condition unless steroids are given at the same time
- Low blood levels of selenium, a dietary mineral.
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