The thyroid gland is a small endocrine gland located at the front of the neck. It functions to produce thyroid hormones that help regulate the body’s energy metabolism. Graves’ Disease, or hyperthyroidism, is an autoimmune disorder that causes the thyroid gland to produce excessive hormones. Increased thyroid hormones can affect the function of all organ systems in the body. Eye symptoms from thyroid disease are common extra-thyroidal manifestations.
Eye Symptoms… from Hyperthyroidism
Hyperthyroidism is a disease caused by an abnormal immune system that excessively stimulates the thyroid gland. It also partially stimulates the muscles and fatty tissues around the eyes, causing inflammation of the eye muscles used for eye movement and inflammation of the orbital fat. This results in bulging eyes, red eyelids, red eyes, a gritty sensation, swollen eyelids, increased eye pressure, inflammation of the inner eye corner, swollen conjunctiva, eye pain, blurred vision, double vision, light sensitivity, and red swollen eyes. In severe cases, it may cause double vision and vision loss. These eye symptoms are often associated with hyperthyroidism (Graves’ disease) but can also occur with hypothyroidism or normal thyroid function. The severity of eye symptoms does not directly correlate with the level of thyroid hormone excess. Treatment of thyroid eye disease is a separate approach, distinct from the treatment of hyperthyroidism itself.
Other Symptoms of Hyperthyroidism
- Enlarged thyroid gland (goiter)
- Rapid and strong or irregular heartbeat
- Trembling hands
- Moist skin due to increased metabolism, easy sweating, skin feels hot and warm as if having a fever
- Thinning hair and easy hair loss
- Weight loss, fatigue, weakness in arms and legs
- Irritability, insomnia
- Frequent bowel movements
- Thickened, swollen, and red skin on the shins or tops of the feet
- Irregular menstruation, which may be scanty or irregular
Causes of Hyperthyroidism
Although the exact cause of this disease is unknown, it is believed that the following factors may trigger the disease more than usual.
- Age and gender: This disease commonly occurs in people under 40 years old, and women are 7-8 times more likely to develop it than men.
- Genetics: If someone in the family has this disease, other family members have a higher chance of developing it.
- Smoking: May affect the immune system and increase the risk of thyroid eye disease.
- Stress: A trigger for the disease, especially in those with a genetic predisposition.
- Illness: Having autoimmune-related diseases such as type 1 diabetes or rheumatoid arthritis increases the risk of hyperthyroidism.
Treatment of Hyperthyroidism
Treatment of hyperthyroidism focuses on inhibiting thyroid hormone production. There are various treatment methods that may differ for each patient depending on factors such as age, pregnancy, and health status. Treatments for hyperthyroidism include:
- Antithyroid medication
This reduces thyroid hormone production. The choice of medication and duration of treatment depend on the physician’s judgment and the patient’s response to treatment.
- Radioactive iodine therapy
Radioactive iodine therapy involves the patient taking radioactive iodine-131 in capsule or liquid form. This substance gradually destroys thyroid cells, reducing hormone production, shrinking the thyroid gland, and improving symptoms over several weeks or months. A disadvantage of this treatment is that most patients develop hypothyroidism and may need lifelong hormone replacement therapy. Additionally, radioactive iodine therapy may worsen eye symptoms in patients with thyroid eye disease, although these effects are usually mild and temporary.
- Surgery
Surgery is considered when other treatments fail, in severe hyperthyroidism, presence of thyroid nodules, suspicion of thyroid cancer, or when large goiters cause compression symptoms. The thyroid gland is surgically removed, but patients will develop hypothyroidism and may require lifelong hormone replacement therapy.
Treatment of Eye Symptoms from Thyroid Disease
The following treatments are available:
- If symptoms are mild, patients may use artificial tears to relieve eye irritation during the day and lubricating gel at night.
- Use of corticosteroids: For severe symptoms, doctors may prescribe corticosteroids to reduce eye swelling. However, corticosteroids have side effects such as fluid retention, weight gain, high blood sugar, high blood pressure, facial swelling, and abdominal swelling due to abnormal fat accumulation.
- Radiation therapy: X-rays are used to destroy some of the tissues behind the eyes. This may be recommended if eye symptoms worsen or corticosteroids alone are ineffective, but it may affect other parts of the eyes.
- Orbital decompression surgery: The surgeon removes bone between the eye sockets and adjacent air sinuses to create more space, allowing the eyes to return to their normal position. This is used when optic nerve pressure is high, risking vision loss.
- Studies have found that selenium supplementation may help in cases with mild eye symptoms.
- Avoid smoking, as it significantly worsens eye symptoms from thyroid disease.
