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Can I Have Hypothyroidism and TED At The Same Time?

Learn about the symptoms of thyroid eye disease and its connection to hypothyroidism.
Can I Have Hypothyroidism and TED At The Same Time?
Last updated:
11/18/2022
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Thyroid eye disease (TED) is a rare and debilitating disorder frequently misunderstood and misdiagnosed. For patients to receive the best care, it is important to understand what TED is and its relationship to other thyroid conditions, such as hypothyroidism or autoimmune diseases like Hashimoto's. Here, we go into what you need to know about TED, including symptoms, treatment options, and the link to thyroid dysfunction.





What is thyroid eye disease (TED??

Thyroid eye disease, also known as Graves’ orbitopathy, is an autoimmune disorder in which tissues and the eye muscles are attacked. The most telltale symptom is inflammation and swelling of the eye tissue, causing the eyes to bulge. Over time, this can lead to pain, double vision, or (in rare cases) loss of vision. There are two phases of TED: the active phase, which can last up to 3 years, and the stable phase, where inflammation stops.

TED can occur at any age, but it is more prevalent in women between 30 and 50 years old. However, symptoms tend to be more severe in men.

What are the symptoms of active thyroid eye disease?

Common eye symptoms include:

  • Staring or bulging eyes
  • Itching, dryness, or gritty sensation in the eyes
  • Eyelid swelling
  • Double vision
  • Feelings of pressure or pain when moving the eyes
  • Difficulty closing the eyes completely

Although symptoms can continue to build, many patients fear they will lose their vision. Fortunately, patients rarely go blind (or experience vision loss) from Graves’ eye disease.

What causes thyroid eye disease?

TED most often occurs in conjunction with patients with Graves’ thyroid disease - about 50% of people with Graves’ also have damage to their eye tissue. Although Graves’ disease doesn’t directly cause TED, they are produced by the same autoimmune mechanism.

In Graves’ autoimmune thyroid disease, the body’s antibodies mistakenly attack the thyroid gland, causing it to secrete excess amounts of thyroid hormone (producing hyperthyroidism). The same antibodies also attack tissues around the eye, causing inflammation and giving rise to TED.

Risk factors for TED include:

  • Cigarette smoking
  • Older age at diagnosis of Graves’ disease
  • Uncontrolled thyroid dysfunction
  • Prior radioactive iodine treatment

The relationship between TED and hypothyroidism

Although TED is most commonly associated with hyperthyroidism (an overactive thyroid gland), hypothyroidism has also been linked in a few cases. Graves’ disease, the autoimmune condition mentioned above, most frequently causes hyperthyroidism but can also cause hypothyroidism. Some research has found that approximately 92.4% of TED patients in their sample had hyperthyroidism, and 7.5% had hypothyroidism.

Furthermore, some evidence shows differences in the presentation of TED with hyperthyroidism and hypothyroidism. Hypothyroid patients had significantly shorter durations of TED symptoms, while cases of TED were milder and more asymmetrical with hypothyroidism.

It is still unclear what the biological explanation of hypothyroidism co-occurring with TED would be. One hypothesis proposed is that the thyroid is attacked by blocking or stimulating antibodies, which can produce either hypothyroidism or hyperthyroidism, depending on the relative concentrations.

What to Do and Treatment For Thyroid Eye Disease

If you have been diagnosed with Graves’ disease or a thyroid disorder and suspect you may have TED, seek an appointment with a specialist to properly test your thyroid hormone levels. With a diagnosis, medical treatment of thyroid eye disease can include eye drops (artificial tears) for dry eyes, selenium supplements, medication, radiation therapy, or (in severe cases) surgical decompression.

Treatment of Graves during the remission phase can involve correcting unacceptable permanent changes that persist after the ocular conditions of the active phase have stabilized. In the second phase, treatment of permanent changes may require surgery to correct side effects such as double vision and reduced eyelid retraction. Surgery may help return the eye to a normal position within the eye socket, also known as orbital decompression.

 

A Note From Paloma

It’s also important to take steps to maintain steady thyroid levels and avoid fluctuations. Getting consistent and regular thyroid blood tests can help you understand where you're current thyroid function is at. Being on the right thyroid medication can help prevent TED symptoms from worsening. You can schedule an appointment with a thyroid expert on palomahealth.com.

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References:

Weiler DL. Thyroid eye disease: a review. Clinical and Experimental Optometry. 2016;100(1):20-25. doi:10.1111/cxo.12472
https://www.tandfonline.com/doi/pdf/10.1111/cxo.12472

Thyroid Eye Disease. www.endocrine.org. Accessed November 17, 2022.
https://www.endocrine.org/patient-engagement/endocrine-library/thyroid-eye-disease

Kashkouli MB, Pakdel F, Kiavash V, Heidari I, Heirati A, Jam S. Hyperthyroid vs hypothyroid eye disease: the same severity and activity. Eye. 2011;25(11):1442-1446. doi:10.1038/eye.2011.186
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3213650/

Eckstein AK, Losch C, Glowacka D, et al. Euthyroid and primarily hypothyroid patients develop milder and significantly more asymmetrical Graves ophthalmopathy. British Journal of Ophthalmology. 2009;93(8):1052-1056. doi:10.1136/bjo.2007.137265
https://pubmed.ncbi.nlm.nih.gov/19221109/

Starrenburg-Razenberg AJ, Castro Cabezas M, Gan IM, Njo TL, Rietveld AP, Elte JWF. Four patients with hypothyroid Graves’ disease. The Netherlands Journal of Medicine. 2010;68(4):178-180. Accessed November 17, 2022.
https://pubmed.ncbi.nlm.nih.gov/20421660/

Thyroid Eye Disease (TED or Graves Eye Disease) | Kellogg Eye Center | Michigan Medicine. www.umkelloggeye.org.
https://www.umkelloggeye.org/conditions-treatments/thyroid-eye-disease 

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Rithana Srikanth

Advocacy Partnerships Specialist at Leapcure

Rithana Srikanth works at Leapcure, building partnerships with advocacy groups and connecting patients with clinical trials. She holds a Bachelor of Science in neuroscience and a Bachelor of Arts in psychology from the University of California, Los Angeles.

Leapcure is an patient advocacy company connecting patients with clinical trials to make research more equitable and efficient.

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