What is Graves’ disease?
Graves’ disease is a disorder in which your immune system damages your thyroid, causing hyperthyroidism. The thyroid is a small gland in your neck that produces hormones that keep your other organs — including your heart, brain, and lungs — working as they should.
In hyperthyroidism, your thyroid is overactive, flooding your body with high levels of thyroid hormones. This leads to symptoms such as:
- Tachycardia (rapid heart rate)
- Tremors in the hands
- Insomnia (difficulty falling asleep or staying asleep)
- Weight loss
- Muscle weakness
Up to half of the people who have Graves’ disease develop eye symptoms and are diagnosed with thyroid eye disease (TED). Thyroid eye disease is also known as Graves’ eye disease or Graves’ ophthalmopathy.
Most cases of thyroid eye disease are mild and easily treatable.
Signs of Thyroid Eye Disease
Eye symptoms typically appear about six months before or after a Graves’ disease diagnosis and can include:
The whites of the eyes or the eyelids may appear red and inflamed. This is often one of the earliest symptoms of graves’ eye disease.
Another early symptom is proptosis, which means your eyes bulge outward. Your eyelids may also retract, leading to dryness and discomfort.
Eye irritation or pain
Your eyes may feel gritty and dry or be excessively teary. They may hurt or be extremely sensitive to bright light (photophobia). You may also have an uncomfortable feeling of pressure in your eyes.
Double vision (diplopia) can be an early symptom of Graves’ ophthalmopathy. If the disease progresses, later symptoms can include trouble moving your eyes, being unable to completely close your eyes, and vision loss.
Causes of thyroid eye disease
In thyroid eye disease, your body’s immune system causes inflammation in the tissues around your eye, which causes redness, swelling, and the other symptoms described above.
The immune system’s attack on your eye also triggers the production of extra muscle and fat in your eye socket. This extra tissue is what causes your eyes to bulge out.
Swelling of your eyelids can make them puffy and red. If the swelling causes your eyelids to retract, your eye is more exposed and therefore more vulnerable to dryness and infection.
In some cases, swelling can stiffen the muscles that move your eye so that they cannot work properly. In 5% of people with Graves’ disease, eye swelling is so severe that it puts pressure on the optic nerves that connect your eyes to your brain, causing vision loss.
People with Graves’ disease who smoke cigarettes are much more likely to have eye symptoms. Their symptoms also tend to be more severe than eye symptoms in people with Graves’ disease who do not smoke.
Diagnosis of thyroid eye disease
If you have already been diagnosed with Graves’ disease, your doctor may diagnose thyroid eye disease based on your symptoms and the signs they observe. They may order imaging such as a computed tomography (CT) scan or magnetic resonance imaging (MRI).
Imaging is painless and can show changes in the structures around your eye that can confirm a thyroid eye disease diagnosis.
Treatments for thyroid eye disease
There are numerous options to help relieve the symptoms of thyroid eye disease. These include:
Lubricating eye drops may help with dryness and irritation. Choose eye drops that do not contain redness removers. If your eyelids do not close completely while you sleep, you can apply a lubricating gel just before bed to prevent dryness.
Applying a cool compress to your eyes may relieve some of the dry, gritty feeling and reduce swelling.
Wearing sunglasses helps protect your eyes from wind and decrease the impact of light sensitivity.
Steroids may help with swelling. There is also a new medicine called teprotumumab-trbw available for the treatment of Graves’ disease. It helps with the symptoms of thyroid eye disease and may reduce your need for eye surgeries.
An ophthalmologist (eye specialist) can reposition eye muscles or the eye itself to fix eyelid retraction or improve your vision. They can also remove scar tissue from your eye muscles to restore movement of your eye.
A surgery called orbital decompression can relieve pressure on your optic nerve to preserve vision.
American Academy of Ophthalmology: “What is a Corneal Ulcer (Keratitis)?”
American Thyroid Association: “Graves’ Disease.”
Harvard Medical School: “Graves’ Eye Disease (Graves’ Ophthalmopathy).”
National Institute of Diabetes and Digestive and Kidney Diseases: “Graves’ Disease.”
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Graves Disease PictureGraves’ disease. Graves’ disease is an autoimmune disease in which your thyroid works harder than it needs to (hyperthyroidism). Some patients develop thyroid eye disease in which their eye muscles and tissues swell, causing the eyes to protrude from their sockets (exophthalmos).
How Does Graves Disease Affect the Body?Graves’ disease is an autoimmune disease that affects the thyroid gland. In this disease, there is an overproduction of thyroid hormones. Thyroid hormones control the body’s metabolism, so they affect almost all the organs of the body.
Hyperthyroidism is an excess of thyroid hormone due to an overactive thyroid gland. Symptoms can include increased heart rate, weight loss, heart palpitations, frequent bowel movements, depression, fatigue, fine or brittle hair, sleep problems, thinning skin, and irregular vaginal bleeding.
Graves' disease is the most common cause of hyperthyroidism. Many other health problems or taking excess thyroid hormone medication can cause an overactive thyroid gland. Treatment for the condition is with medication, radioactive iodine, thyroid surgery (rarely), or reducing the dose of thyroid hormone. No diet has been shown to treat hyperthyroidism or its symptoms and signs.
methimazole, TapazoleMethimazole (Tapazole) is a medication used to treat hyperthyroidism. Grave's disease is the most common cause of hyperthyroidism. Review side effects, drug interactions, dosage, and pregnancy safety information prior to taking methimazole.
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Propylthiouracil (PTU)Propylthiouracil (PTU) is a medication prescribed to manage hyperthyroidism and Graves' disease. The most common side effects are related to the skin, such as rash, itching, hives, abnormal hair loss, and skin pigmentation. Since methimazole is associated with fetal abnormalities, PTU is used during the first trimester if an antithyroid drug is needed. PTU is excreted in breast milk in small amounts.
tetrahydrozoline ophthalmicTetrahydrozoline ophthalmic is an over-the-counter (OTC) eye drops medication used for the temporary relief of red eye due to minor eye irritations, and to protect the eye from further irritation. The medication provides temporary relief but does not treat the underlying condition. Common side effects of tetrahydrozoline ophthalmic include transient burning and stinging in the eyes, blurred vision, headache, tremor, palpitations, rapid heart rate (tachycardia), palpitations, and high blood pressure (hypertension).
Thyroid Disorders Symptoms and SignsThyroid diseases and disorders are caused because the body either makes too much or too little thyroid hormones, which are necessary for vital functions of the body.
Thyroid disease and disorder symptoms and signs depend on the type of the thyroid problem. Examples include heat or cold intolerance, sweating, weight loss or gain, palpitations, fatigue, dry skin, constipation, brittle hair, joint aches and pains, heart palpitations, edema, feeling bloated, puffiness in the face, reduced menstrual flow, changes in the frequency of bowel movements and habits, high cholesterol, hoarseness, brittle hair, difficulty swallowing, shortness of breath, a visible lump or swelling in the neck, tremors, memory problems, depression, nervousness, agitation, irritability, or poor concentration.
Thyroid problems are more common in women.
Thyroid DisordersThere are several types of thyroid disorders including hypothyroidism, hyperthyroidism, goiters, thyroid nodules, and thyroid cancer. Symptoms vary by condition. Diagnosis is made with blood tests, scans, ultrasound, or biopsy. Treatments depend on the disorder and can include medication or surgery.
Thyroid ProblemsThe thyroid gland is a butterfly-shaped gland located in the front of the neck. The thyroid gland produces important thyroid hormones, which are produced by the pituitary gland. There are six types of thyroid problems. Home remedies, medications, surgery, lifestyle changes, and surgery. Usually, most types of thyroid problems can be managed with home remedies, medications, lifestyle changes (diet, yoga), and surgery.
What Kind of Doctor Treats Thyroid Eye Disease?Thyroid eye disease, also known as Graves’ orbitopathy or Graves' ophthalmopathy, is an eye condition that happens in a person with an overactive thyroid. Most eye surgeons (ophthalmologists) and hormone specialists (endocrinologists) will be in contact with an oculoplastic surgeon with experience in treating patients with thyroid eye disease.
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