Thyroid eye disease (TED) is a rare condition that occurs when an overactive thyroid gland affects the muscles and fat around the eyes. Thyroid stimulating hormone (TSH) is produced by the pituitary gland. Its role is to regulate the production of hormones by the thyroid gland.

Of those with thyroid disease, the vast majority have an underactive thyroid (hypothyroidism), while only a small minority have an overactive thyroid (hyperthyroidism).

Hyperthyroidism occurs when the thyroid gland generates too much thyroid hormone. This can lead to several problems, including bulging eyes, redness, irritation and dryness. In severe cases, it can cause double vision, blurred vision, difficulty closing the eyelids or complete vision loss.

Thyroid eye disease is most commonly diagnosed in people aged 40-60, and women are mostly affected than men. Although the precise prevalence of thyroid eye disease—i.e., the proportion of people with the condition in a given population at a given time—is unknown, it is estimated as 16 per 100,000 women and 2.9 per 100,000 males.

In addition, the condition is mostly associated with other autoimmune diseases, such as Graves or Hashimoto’s.

Do you think you may have a thyroid eye disease? Then it is important to see an ophthalmologist or endocrinologist for a proper diagnosis. Treatments are available to help manage the symptoms and improve the appearance of the eyes.

What is Thyroid eye disease (TED)?

Thyroid eye disease (TED), also called Graves’ orbitopathy or Graves’ ophthalmopathy, is an autoimmune disease that affects the tissues and muscles around the eyes. Frequently, it leads to strabismus (crossed eyes).
There are two phases of TED. They include:
1. The inflammatory or active phase.
2. The stable phase.

• The active phase is a phase when most symptoms occur and the disease is most active. Symptoms may include bulging of the eyes, redness and irritation, dryness, tearing, double vision, and difficulty moving the eyes.  This phase also associates with Graves’ disease that affects the thyroid gland. This phase can last for months to years.

• The stable phase on the other hand, begins after the inflammation subsides. This phase is typically reached after several years and is characterized by little or no change in symptoms or orbital tissue damage. This phase may last for many years or even be permanent.

The majority of people with TED will notice some changes in their vision. It gradually starts and gets worse over time. TED can cause the muscles and tissues around the eyes to swell. It can also make your eyes look bulgy and cause vision problems. In severe cases, TED can damage the nerves that control the eye muscles, leading to double vision.

Thyroid eye disease is a very serious and rare condition that can be debilitating and even blinding if left untreated. Early diagnosis and proper treatment are essential to prevent the disease from progressing and causing permanent damage.

Causes of Thyroid Eye Disease

Thyroid eye disease (TED) is commonly caused by an overactive thyroid gland, which produces too much of the hormone thyroxine. In the end, it causes the muscles and fatty tissues around the eyes to swell, resulting in bulging eyes and a puffy appearance.

There are many different causes of TED, but the most common one is Graves’ disease. Graves’ disease is an autoimmune disorder that mainly causes the body to produce too much thyroxine. Thyroid-stimulating immunoglobulin is an abnormal antibody produced by the immune system in people with Graves’ disease.

Ordinarily, this antibody mimics the pituitary gland which produces this thyroid-stimulating hormone. The condition’s symptoms are a result of these abnormal antibodies, which also harm the cells in the area around the eyes.

However, not everyone with TED is prone to experience immune system abnormalities. If you have Graves’ disease, the most common type of thyroid eye disease, you may need to avoid foods high in iodine. This is because iodine can worsen the symptoms of Graves’ disease. Foods high in iodine include seafood, seaweed, eggs, and dairy products.

Thyroid eye disease (TED) is mostly confused with Graves disease (GD) mainly because they are two autoimmune conditions that often occur together. In Graves disease, the thyroid gland is affected, while in TED, the muscles and fat behind the eyes are affected.

While it is true that many people are commonly diagnosed with Graves’ disease before a TED diagnosis, this isn’t always the case. In reality, about 1 in 10 TED patients experience a TED-only diagnosis. This implies that a person can develop TED without having the graves’ disease.

Both TED and GD can cause inflammation and damage to the eye, leading to vision problems. There is currently no cure for TED or GD, but treatment can help manage the symptoms and slow the progression of the diseases.

Some common symptoms of TED and GD include redness and swelling of the eyes, pain in the eyes, blurry vision, sensitivity to light, and difficulty moving the eyes.

If you experience any of these symptoms, immediately see an ophthalmologist or other eye specialist. TED and GD are both serious conditions that may lead to vision loss if left untreated. However, many people with TED or GD can maintain good vision with early diagnosis and proper treatment.

Is there a relationship between thyroid eye diseases and blepharitis?

Yes, there is a relationship between thyroid eye diseases and blepharitis. Both conditions involve the inflammation of the tissues around the eye, and both can cause symptoms like redness, pain, and swelling.

One study found that people with TED were likelier to have blepharitis than those without TED. Another study found that people with TED  have a high risk of developing blepharitis if they had certain genes associated with autoimmune diseases. Treatment for both conditions typically includes the use of anti-inflammatory medications.

Symptoms of Thyroid eye disease

The severity of eye problems, as well as their manifestation, varies from person to person. For some people, the symptoms cause discomfort, damage to the eye socket, and, finally, a risk to their eyesight.

For some people, the disorder doesn’t change for years, while it worsens or gets a little better for others. So many signs and symptoms indicate the presence of a thyroid eye disease.

The most common and recognizable symptom is bulging of the eyes, which occurs when the muscles behind the eyeballs become enlarged and push the eyeballs forward. This gives the appearance of a ‘staring’ or ‘bug-eyed’ look.

Other symptoms include:

• Double vision
• Eyelid retraction, where the eyelids pulls back and away from the eyes
• Dry eyes
• Excessive tearing
• Pain in or around the eyes
• Sensitivity to light

In case you are experiencing any of these symptoms above, it is important to see an optometrist or ophthalmologist for an assessment as soon as possible, as early diagnosis and treatment can help to prevent or reduce further damage to the eye.

Diagnosis

There are several ways to diagnose thyroid eye disease. To diagnose Thyroid Eye Disease (TED), a thyroid antibody test should be carried out.

A thyroid antibody test is a blood test that measures the levels of antibodies in your blood. Antibodies are proteins that your body produces in response to foreign substances, such as viruses or bacteria.

The thyroid antibody test is used to detect autoimmune disorders of the thyroid, such as Graves’ disease or Hashimoto’s disease.

Other diagnostic tests includes:

• Imaging tests: Imaging tests, such as MRI or CT scans, help to diagnose TED. These tests can help to assess the severity of the condition and to identify any complications. Imaging tests can also help to monitor the progression of TED and to see how well treatments are working.

• Biopsy: A biopsy test for TED is usually performed as an outpatient procedure. Here, the doctor takes a small sample of tissue from the affected eye and sends it to the laboratory for analysis. The results of the biopsy test can help to determine the best course of treatment for TED.

What to do to prevent thyroid eye diseases

There are various things you can do to prevent thyroid eye disease:

1. Get regular checkups with an ophthalmologist or optometrist. This way, if you have any early signs of the disease, you can catch it and treat it early.

2. If you have Graves’ disease or hyperhtyroidism, follow your treatment plan and take your medication as prescribed. This can help to prevent the disease from getting worse.
3. Avoid smoking. Smoking is a risk factor for many diseases, including thyroid eye disease. If you smoke, quitting is the best thing you’ll be glad to do for your health.

4. Eat a healthy organic diet and exercise regularly. This will help to keep your immune system strong, which may also help to prevent the development of autoimmune diseases like Graves’ disease.

5. Manage stress with moderate exercises, pilates, relaxation techniques, music therapy, etc.
6. Avoid environmental toxins, chemicals and heavy metals ( in food, water, products, dental work etc).

Treatments for thyroid eye diseases

The purpose of treatment is to guard the front of the eye and stop vision loss while limiting inflammation and swelling during the active or inflammatory phase. Your eye doctor may suggest one or all of the following modes of treatments if you have thyroid eye disease to help calm your eyes and enhance your vision:

Medications

Many different types of medications help to treat the various symptoms of thyroid eye disease. These medications can reduce the inflammation and swelling of the eye, while others can help improve vision and prevent further damage to the eye. The most common medication used to treat thyroid eye disease is corticosteroids.

• Immunosuppressants: They help to suppress the immune system, which can reduce the amount of inflammation around the eye.
• Antithyroid drugs: Are used to treat an overactive thyroid gland, which can cause Graves’ disease, one of the most common forms of thyroid eye disease.

• Beta-blockers: Doctors commonly use them to treat high blood pressure, but they can also help reduce some symptoms of Graves’ disease, such as bulging eyes and eyelid retraction.
• Low-dose naltrexone (LDN) therapy: Is a treatment can treat patients with Grave’s diseases. LDN works by obstructing a chemical produced by the body called endorphin. Endorphins are responsible for the “feel-good” sensation that people experience after exercising, eating, or taking certain drugs. LDN is safe and effective.

• TEPEZZA (teprotumbumab medication for the thyroid eye diseases): is a medication used to treat thyroid eye diseases. It is a monoclonal antibody that binds to and inhibits the activity of the protein tyrosine kinase, which is also involved in the development and progression of the disease.  If you are considering TEPEZZA for treating your thyroid eye disease, discussing all potential risks and benefits with your doctor is important. TEPEZZA is generally well-tolerated, but as with any medication, there is always a chance of side effects. Tell your doctor about allergies or other medical conditions before starting treatment with TEPEZZA.

Surgery

There are three types of surgery for treating thyroid eye disease: orbital decompression, eyelid surgery and eye muscle surgery.

Orbital decompression: The optic nerve provides the link between your eye and brain.

But in cases when the nerve squeezes, colour perception changes, lights may appear dimmer than usual, and eyesight sharpness will decline. As a result, you need to undergo orbital decompression surgery to enhance your vision. This surgery treats Graves’ orbitopathy, also known as thyroid eye disease.

This surgery creates more space in the eyelids and orbits of the eyes. In addition, it removes part of the bone, fat, and muscle around the eyes.

• Eyelid surgery: Tight eyelids prevent your bottom lid from lifting and your top lid from lowering. A corneal injury may result from this. Eyelid surgery is one way to keep your cornea covered.
• Eye muscle surgery: To help you correct double vision, your doctor may recommend moving your eye muscles during surgery.

Radiation

Radiation therapy is highly effective for treating thyroid eye disease and can often help improve symptoms and appearance. It works by targeting the overactive cells in the eye that are causing the disease and destroying them. This can help to reduce inflammation, improve vision, and prevent further damage to the eye.

There are a few radiation therapies that can treat thyroid eye disease, and your doctor will determine which is best for you based on the severity of your disease.

One of the most common radiation therapy is external beam radiation therapy, which involves using a machine to deliver high-energy radiation directly to the eye. This radiation therapy is usually given in small doses for several weeks.

Another type of radiation therapy for treating thyroid eye disease is the internal radiotherapy or brachytherapy. This involves placing a tiny radioactive pellet inside the eye near the overactive cells.

The pellet gives off low radiation levels over time, which helps destroy the overactive cells without damaging healthy tissue. Doctors typically administer brachytherapy in one or two sessions, and it does not necessitate any hospital stay.

Regardless of the type of radiation therapy you receive, some side effects may occur. These include fatigue, dry eyes, and skin irritation around the eyes. However, most side effects are temporary and will disappear after treatment.

Home remedies

Many home remedies can help relieve the symptoms of thyroid eye disease. Some of these include:

• Take a warm bath or use a heating pad on the affected area to help relieve pain and swelling.
• Manage stress with moderate exercises, pilates, relaxation technique, music therapy etc.

• Avoid environmental toxins, chemicals (pesticides in food and water), and heavy metals.
• Use eye drops lubricants to help keep your eyes moist and prevent dryness.
• Wear sunglasses or protective eyewear when outdoors to help shield your eyes from wind and bright light.

• Sleep with your eyelids taped shut. Lack of eye closure can cause dryness and corneal ulcers, leaving scars on the eyes and impairing vision.
• Using prism-equipped glasses to cut down on double vision.

Vitamins and supplements for thyroid eye diseases

Many different vitamins and supplements can be beneficial for thyroid eye disease. Below are some of the most popular and effective options:

• Vitamin A: This vitamin is important for vision and immune function and can help protect the eyes from dryness and irritation.
• Vitamin C: This essencial vitamin is a highly effective and powerful antioxidant that helps to reduce inflammation and improve circulation. It also helps to produce collagen, which is vital for healthy skin and connective tissues.

• Vitamin D3;Vitamin B-12.

• Vitamin E: This vitamin has anti-inflammatory properties that can protect the eyes from damage caused by free radicals.

• Selenium: This trace mineral is essential for thyroid function and can also help reduce inflammation. It is a mineral that is frequently present in soil and is also present in small amounts in many foods. However, researchers are still determining whether people living in selenium-rich areas would experience the same benefits, as studies on the subject have only been conducted in areas where selenium was uncommon in the soil.
• Zinc: Zinc is important for many different functions in the body, including immune function, cell growth, and wound healing. It can also help to protect the eyes from any damage caused by UV rays.
• Omega-3 fatty acids are important for heart health and cognitive function. Fish oil supplements or foods like salmon, mackerel, and herring contain them. Supplementing with omega-3 fatty acids may help reduce the risk of developing Graves’ Disease.
• L-carnitine or Acetyl L-carnitine Supplement: Studies have shown L-carnitine to be a highly effective supplement that can reverse the symptoms of grave’s disease and hyperthyroidism. It is a treatment option worth exploring. However, you should speak with your doctor about whether L- carnitine is right for you.

What can I eat with thyroid eye disease?

What you eat can help to improve your symptoms and help to keep your eyes healthy. Some people with thyroid eye disease may have blurry vision, while others may see double. Still, others may experience dry eyes or watery eyes. Below are some tips on what to eat if you have thyroid eye disease:

• Eat plenty of fresh fruits and vegetables. These contain nutrients that can help to improve your vision.
• Include fish in your diet. Fish such as salmon, tuna, and herring are rich in omega-3 fatty acids, which can help to reduce inflammation in the eyes.
• Eat foods high in antioxidants. These include dark leafy greens, berries, and tomatoes. Antioxidants can help to protect the cells in your eyes from damage.

• Increase your vitamin A intake by eating carrots, sweet potatoes, and dark leafy greens. Vitamin A is important for good vision.
• Cutting out processed foods and eating a diet rich in whole, unprocessed foods is also important for managing thyroid eye disease.

• You should also drink plenty of water to keep your eyes hydrated.

Finally, if you wear contact lenses or glasses, clean them regularly to prevent infection. Also, consider switching to daily disposable contact lenses if you have dry eyes or other problems with your eyesight.

Conclusion

Diseases of the thyroid are becoming increasingly common, with Graves’ disease and hyperthyroidism being the root of this illness.

Luckily, there are effective treatments available for both Graves’ disease and hyperthyroidism such as the LDN therapy and L-carnitine.

The use of LDN therapy should be under medical supervision. While the use of the supplement L-carnitine and Acehyl L carnitine are very effective in reversing the symptoms of hyperthyroidism and Graves’ disease. This supplement works by inhibiting the excess of thyroid hormones and helping with high pulse rate and/or palpitations.

Usually, many people do not get enough vitamins and minerals from their diet and may need to take supplements to correct those deficiencies. It is also important to avoid environmental chemicals, heavy metals to avoid developing autoimmune diseases that can cause Thyroid eye disease.