Yes, you can have Thyroid Eye Disease (TED) without having Graves' disease; while TED is most common with Graves' hyperthyroidism, it's an autoimmune condition that can also occur with normal or low thyroid function (hypothyroidism, Hashimoto's) and even in people with normal thyroid levels, affecting the eye tissues directly. About 1 in 10 TED patients don't have Graves' disease, and symptoms can sometimes appear before or at the same time as the thyroid diagnosis.
Thyroid eye disease is closely linked to thyroid disorders, especially an overactive thyroid condition known as Graves' disease. TED occurs when the immune system mistakenly targets the muscles and connective tissues around the eyes, causing inflammation and other symptoms.
Thyroid Eye Disease (TED) is a rare eye condition. That's why you shouldn't visit just any doctor. If you think you may have TED, you should see a TED Specialist. They have the experience to diagnose TED and provide you with the treatment and care you may need.
In TED, the immune system attacks the muscle and fat tissue behind the eyes. Autoimmune diseases are chronic, or lifelong, conditions. The fact that people with Graves' disease often develop TED also causes confusion. However, a person can develop TED without having Graves' disease.
This condition also is called underactive thyroid. Hypothyroidism usually isn't linked to eye disease. In severe cases, however, hypothyroidism may cause swelling around the eyes. It also may cause a loss of hair in the outer part of the eyebrows.
In some people, thyroid eye disease can occur with normal levels of thyroid hormones (euthyroid) or low levels of thyroid hormones (hypothyroidism). Thyroid eye disease may occur in patients who already know they have thyroid disease, or it may be the first sign of Graves' disease.
Metastases, lymphoma, and sarcoid are three examples of disorders that could cause eye muscle enlargement simulating TED. While patients with TED may complain of a mild pain in their eye socket that could be worsened with eye movement, the pain should not be severe.
How does Thyroid Eye Disease progress? There are two phases of Thyroid Eye Disease (TED) or Graves Eye Disease. The active phase, marked by inflammation, usually lasts from six months to two years. The focus during this stage is on medical treatment to relieve the eye symptoms.
The ophthalmologist will test your vision, color vision, and visual fields. In addition, eyelid measurements will be taken, eye pressure tested, and optic nerve checked. An exophthalmometer will be used to measure the degree (if any) of eye bulging and if and how far forward your eyes have moved due to TED.
The Role of Stress in Graves' Disease and TED
Some people with Graves' also develop TED, a condition where the immune system attacks tissues around the eyes. TED can lead to eye bulging, pain, dryness, and even vision problems. Stress is a major factor in both conditions.
Eye problems
The ability to identify patients with active orbital inflammation makes STIR-sequence MRI a preferred imaging technique for thyroid eye disease.
To help reduce dryness and discomfort, you can use saline eye drops (artificial tears) during the day. And at night use an eye ointment or gel. Wearing glasses or sunglasses will help protect your eyes from light, cold, and wind. Raising the head of your bed at night will also help reduce your symptoms.
Thyroid conditions are also more common in women. External examination: Observing the eyes allows the doctor to check for bulging, redness, or swelling. Internal examination: The eye doctor can measure eye pressure to evaluate glaucoma risk, which is associated with thyroid eye disease.
TED is more common in women than men, though men are more likely to have more severe eye disease. The condition can affect people of any age, though it typically occurs in those between ages 30 and 50, and it is less common in children.
Symptoms of thyroid eye disease include: Feeling of grittiness in your eyes (like “sand in your eyes”) and sensitivity to light. Pain behind your eyes or with eye movement.
In thyroid eye disease the tissue around the eye is attacked by inflammatory cells and the result is inflammation, swelling, and bulging of the eye. Thyroid disease and thyroid eye disease both come from the immune system attacking healthy tissue. We now know one disease does not directly cause the other.
Free T3 and T4 tests provide a clearer picture of thyroid activity by measuring these hormones' unbound, active forms. Abnormal levels of T3 and T4 can contribute to the development or worsening of thyroid eye disease. Elevated T3 and T4 levels suggest hyperthyroidism, leading to increased inflammation around the eyes.
The number one risk factor for developing active thyroid eye disease is smoking — smokers are seven times more likely to be affected by thyroid eye disease. Women are six times more likely than men to be affected. Other risk factors include uncontrolled thyroid disease and family history of thyroid eye disease.
Often the doctor will order an MRI or CT scan of the brain and orbits. In patients with Thyroid Eye Disease, this test will show which muscles are affected and exclude other conditions. Finally, the doctor will check blood work, especially to see if there are thyroid abnormalities in addition to eye problems.
Beyond food, lifestyle factors like smoking, stress, and poorly managed thyroid hormone levels can exacerbate TED. Smoking, in particular, is one of the worst offenders, as it directly worsens inflammation and reduces the effectiveness of treatments like Tepezza.
Thyroid eye disease cannot be cured completely, but its symptoms can be managed effectively with appropriate treatment. The goal of treatment is to control the progression of the disease, alleviate symptoms, and improve the overall appearance and function of the eyes.
Graves' eye disease, also known as thyroid eye disease, is an autoimmune condition in which immune cells attack the thyroid gland which responds by secreting an excess amount of thyroid hormone. As a result, the thyroid gland enlarges and excess hormones increase metabolism.
In cases where there is more significant inflammation your eyes may need to be treated with steroids which aim to suppress the immune system which is affecting the tissues behind the eyes. These should help reduce redness and swelling of the eyes and the eyelids and can help with double vision,.
TED is commonly misdiagnosed, not only because of the heterogeneity of presenting symptoms and signs, but also because the thyroid gland symptoms and ocular symptoms can occur at different times. Early in the active phase, symptoms are commonly blamed on dry eye disease, conjunctivitis, or allergic eye disease.