Is My Thyroid Eye Disease Caused By Hashimoto’s Thyroiditis?

The thyroid is a butterfly-shaped gland that sits at the front of your neck. This gland secretes hormones that affect a variety of body functions, including heart rate, body temperature, and metabolism.

Any issues with your thyroid gland and the production of thyroid hormones can affect many different areas of the body, including your eyes.

It's estimated that 16 out of every 100,000 women and nearly 3 out of every 100,000 men¹ suffer from a condition called thyroid eye disease. This condition can occur in anyone, even those with a normally functioning thyroid, but it's prevalent alongside certain thyroid disorders.

If you've been diagnosed with thyroid eye disease (TED), understanding the link between your thyroid function and your eyes may help you discuss treatment options with your doctor. Learn more about thyroid eye disease, its causes, treatments, and the link to Hashimoto's disease.

What is thyroid eye disease?

Thyroid eye disease (TED) is an autoimmune disorder. It's also known as Graves' ophthalmopathy or Graves' orbitopathy. TED occurs when the body's immune system attacks the tissue surrounding the eye, including the eye muscles and tear ducts.

This causes inflammation in the tissue, leading to watery eyes and light sensitivity. It may also change the appearance around the eye area, causing the eyes to bulge or protrude outwards.

Symptoms of thyroid eye disease can range from very mild to severe. In rare cases, thyroid eye disease can cause permanent vision loss.

Anyone can develop thyroid eye disease, but around 40% of people with Graves' disease develop thyroid eye disease.² Grave's disease is also an autoimmune disease affecting the thyroid, which causes the gland to secrete too much thyroid hormone (hyperthyroidism.)

You do not need an overactive or underactive thyroid to develop thyroid eye disease. The gland may function normally while your body's immune system attacks the tissues around the eyes.

Symptoms of thyroid eye disease

Symptoms can range from mild to severe and include:

• Watery eyes

• Light sensitivity

• Double vision

• Blurry vision

• Bulging eyes

• Swollen upper or lower eyelids

• Dry eyes

• Eye redness 

• Pain when trying to move the eyes, such as when trying to look up or down

It can take a long time to diagnose thyroid eye disease, as mild symptoms are similar to hayfever and conjunctivitis. Some symptoms, such as pain when looking up, down, or to the side, are usually due to thyroid eye disease.

Your doctor or ophthalmologist can eliminate other potential health concerns and determine if your eye issues are due to thyroid eye disease.

Complications of thyroid eye disease

The majority of people with TED experience mild symptoms.³ However, a small number of patients may experience moderate-to-severe symptoms. An even smaller number may experience severe symptoms that impact their quality of life.

There is a very small risk that inflammation around the eye can become so severe that it places pressure on the ocular eye nerve. This may result in a loss of vision.

Can Hashimoto's thyroiditis cause thyroid eye disease?

In rare cases, yes. While it's more common for those with Graves' disease to develop the condition, around 6% of those with Hashimoto's disease develop thyroid eye disease.⁴

Hashimoto's thyroiditis, also known as Hashimoto's disease, is another autoimmune disease affecting the thyroid gland. Unlike Graves' disease, which causes hyperthyroidism, Hashimoto's thyroiditis causes hypothyroidism as your immune system attacks the thyroid gland itself.

Eventually, your body destroys parts of the thyroid gland permanently. This can take months or years to happen, but over time, the thyroid gland becomes unable to create enough thyroid hormone due to the damage done by the body’s immune system.

The lack of thyroid hormone in the body is called hypothyroidism.

Symptoms of Hashimoto's disease include:

• Feeling tired

• Unexplained weight gain

• Pain in the joints and muscles

• Heavy periods 

• Slow heart rate

• Increased cold sensitivity

You are at higher risk of developing thyroid eye disease if you smoke, are older, and have had Hashimoto's disease for a long time.

The most common Hashimoto-induced thyroid eye disease symptom is dry eyes. Your tear ducts rely on hormones from the thyroid gland to produce lubrication for your eyes. Along with dry eyes, you might experience:

• Blurred vision

• Eyelids that swell or don't close completely

• Eyelashes and eyebrow hairs that fall out

Thyroid eye disease is a temporary condition with an active phase that lasts up to two years. After that, most of the symptoms will disappear, but it may cause long-term effects such as double vision.

How to lower your risk of developing thyroid eye disease

Anyone can develop thyroid eye disease, even if they don't have a thyroid disorder.⁵ However, around 25% of those with Graves' disease and 6% of those with Hashimoto's disease develop thyroid eye disorder. While most people have mild symptoms, if your case is severe, it can impact your quality of life and result in vision loss.

There are ways to lower your risk of developing a thyroid eye disease, including: 

Stop smoking

One of the best things to reduce your risk of developing thyroid eye disease is to stop smoking. If you smoke, you double your risk of developing thyroid eye disease.⁶ If you are a heavy smoker, you are eight times more likely to develop thyroid eye disease than non-smokers.

Smokers are much more likely to experience worsening symptoms⁷ and poorer responses to treatment. If you currently smoke, stopping smoking as soon as possible can help prevent the disease from getting worse and give you a better treatment outcome.

Manage your thyroid disorder

If a physician has diagnosed you with a thyroid disorder, follow your primary care provider or endocrinologist’s treatment plan. If you start experiencing eye problems, this may indicate a change in your condition or that you need an adjustment in your medication. Early treatment may also prevent your symptoms or condition from worsening. 

Avoid radioactive iodine therapy

Radioactive iodine therapy is a common treatment for many thyroid conditions, including Graves' disease. However, there are signs that this therapy may make thyroid eye disease worse.⁸ Some patients' worsening symptoms go away after a few months, but some require medical intervention. Because of this, it may be best to avoid radioiodine therapy in favor of other treatment methods.

Studies have also indicated that being male and older⁹ can increase your risk of developing more severe forms of thyroid eye disease.

Treating thyroid eye disease

Thyroid eye disease is a temporary condition. The disease goes through an active phase that lasts between six months and two years on average. During this time, the symptoms of thyroid eye disease will get worse. After the period of active inflammation, the body's healing response activates, stopping many active symptoms. Any remaining symptoms may be treated with special eyeglass lenses, medication, or surgery.

Treatment for thyroid eye disease is often a collaborative effort between you and your primary care provider and may potentially also involve an:

• Ophthalmologist: A doctor that specializes in treating eye conditions. 

• Endocrinologist: A doctor who treats the endocrine system, including your thyroid and other hormone-secreting organs.

You and your healthcare team can determine which treatment options are best for you based on your symptom severity and any other medical concerns.

Treatment for mild thyroid eye disease will focus on managing your symptoms and may include:

Artificial teardrops

This might be liquid, gel, or ointment. They lubricate the eye's surface and eliminate symptoms such as dry, gritty eyes. Depending on your doctor's recommendation, these drops may be over-the-counter or by prescription.

Steroid treatment

Steroids can reduce the inflammation in the tissue around the eye, and they may eliminate double vision that remains after the active phase of the disease. For the most severe cases, steroid treatment can restore some vision loss.

Prism lenses

Adding a prism to your lenses can eliminate issues with double vision.

You can also do treatments at home, such as warm compresses on your eyes to ease inflammation and soreness.

For the most severe cases of thyroid eye disease, surgery may be the best option. Surgeries include:

Decompression surgery

Inflammation can place pressure on the optic nerve, leading to vision loss. Decompression surgery aims to create space behind the eyeball and relieve pressure on the optic nerve. 

Eye muscle surgery

This can correct double vision, which may be a problem even after the active phase of the disease.

Eyelid surgery

If your eyelids aren't closing entirely or have become misshapen due to the disease, this surgery can restore their eye-protective function.

In 2020, the FDA approved the drug teprotumumab-trbw,¹⁰ also known as Trepezza®, for treating thyroid eye disease in the United States. The medication inhibits the process that causes TED. The drug may improve symptoms, including double vision and bulging eyes.

When to see a doctor about thyroid eye disease

If you have been diagnosed with a thyroid disorder such as Hashimoto's disease or Graves' disease, your primary care physician or endocrinologist should monitor you for thyroid eye disease as well.

Let your doctor know if you have any new symptoms, such as dry eyes, double vision, or swollen eyelids. The earlier you start treatment, the better the outcomes for TED.

If you don't have a diagnosed thyroid condition but are experiencing some of the symptoms of thyroid eye disease, make an appointment with your primary care provider. This condition shares many symptoms with common medical conditions such as hayfever and conjunctivitis. Your doctor can order tests to determine the underlying medical cause of your symptoms.

The lowdown

Thyroid eye disease (TED) is an autoimmune disorder that causes the body's immune system to attack the tissue around the eyes. It causes dry, gritty eyes, blurred or double vision, and pain when moving the eyes up and down or from side to side. It may also cause bulging or protruding eyes.

The disease is temporary, going through an initial active period that lasts between six months and two years. During this time, the symptoms may get worse.

After the active phase, the disease goes into an inactive phase, where most symptoms will start to go away. Treatment during the active phase will focus on managing your symptoms with eye drops, warm compresses, and special lenses. Treatment in the inactive phase is only required if there are lingering effects, such as surgery to correct double vision or damaged eyelids.

If you've been diagnosed with a thyroid disorder and are experiencing new symptoms linked to thyroid eye disease, speak to your treating physician. If you don't have a history of thyroid problems but are experiencing symptoms of thyroid eye disease, make an appointment with your doctor.