Thyroid Eye Disease

Thyroid eye disease is an autoimmune condition where your body makes hormones and proteins that cause swelling and scarring of the muscles and tissues around the eye balls.

This condition may occur before, during, or after thyroid gland abnormalities.  Sometimes in thyroid eye disease the thyroid hormone levels are in the normal range. Sometimes the eye disease presents many years after a bout of thyroid hormone imbalance.  The immune system connects the eyes and the thyroid gland. The immune system can attack the eye muscles and the thyroid gland causing the gland to malfunction. Usually the gland overproduces thyroid hormone that in turn can lead to tremors, shakes, weight loss, rapid heart beat or palpitations, nervousness, and sensitivity to heat. Less commonly the thyroid gland produces low levels of hormones causing fatigue, constipation, weight gain, dry skin and hair or even swelling in the body. Antibodies to the thyroid gland can be looked for in a simple blood test.

Thyroid eye disease can result in bulging of the eyes (proptosis), retraction of the lids, double vision, decreased vision, “bags” under the eyes, puffy upper lids as well as red & sore eyes.

Thyroid eye disease has an ACTIVE phase and an INACTIVE phase. The active phase typically last from 6 months to 2 years after the onset of symptoms. During this stage the eyes and surrounding tissues may be actively changing. The eyes may progressively bulge, double vision may occur and get worse or improve and the vision may decrease in one or both eyes.


It is important to get regular check-ups to test your vision and color vision during this phase. We usually recommend at least every 3 months. Also if you notice any change in your vision, you must call your ophthalmologist and make an urgent appointment. Sometimes swelling behind the eye can push on the optic nerve (vision nerve) and damage it. Vision loss may be reversible with TIMELY treatment with medication, radiation treatment, or surgery

Surgical Options

If the swelling is pushing on the optic nerve, then we can do a surgery called an orbital decompression. In orbital decompression, the surgeon creates fractures of the thin bones of the orbital walls, allowing the orbital contents to be displaced into the sinuses.  This permits a significant diminution of proptosis, ie, the bulging eyes fall backward into the orbit, creating a more natural appearance. 

There are also procedures that can be done to help with the swelling around the eyes, such as a blepharoplasty to remove excess skin and fat. We can also do what's called an eyelid lengthening to reduce eyelid retraction, and also a tarsorrhaphy, which diminishes the appearance of the bulging by making the eye opening smaller. 

Management Tips

1. Know the value of your sleep and improve your sleeping habits

Sleep deprivation or low quality sleep will affect all aspects of your life. Mental, emotional, and physical performance, immune system and productivity start to fail when with low quality sleep. Depression, weight gain, and memory loss are just a few issues that could be aggravated by bad sleeping habits.


Remember these tips to improve your sleep:

● Avoid screens and artificial light before bedtime. Read a book or talk to your family members before bedtime instead. If you have a hard time falling back asleep in the middle of the night, don’t look at your phone! That will make it harder for your body to fall asleep. If you really have to look at your computer or phone before bed, install an application that filters out the blue light on them.

● Try to get up with the sun and get out in the daylight and don’t stay up late. Sunlight exposure during the day triggers your body to produce optimal daytime and nighttime hormones, and it regulates your biological clock. Getting out in the sunlight during the day, especially between 6-9 am as well as limiting artificial light exposure in the late evening can keep the biological clock running properly.

● Minimize your caffeine consumption in the evening. You could still fall asleep when you’ve had caffeinated drinks, but when there is still caffeine in your bloodstream, your body will have trouble going into a type of sleep called “deep sleep”. If you don’t get enough deep sleep, your body won't recover from daily activities and won’t function as it should.

● Sleep in a completely dark room. Your body naturally sleep better in a dark environment. Having even a little bit of sunlight or artificial light will decrease the quality of your sleep. Light is also absorbed through your skin so just using an eye mask is not enough.

● Try to do some exercise daily, but don’t exercise at least 2 hours before bedtime

● Be careful with alcohol consumption. Having a little drink before bed makes more people drowsy, but with alcohol in your blood your body won't go into a deep sleep and that makes your sleep cycle even worse for the next few days and as was mentioned if you don’t get some deep sleep every night your body won’t recover and function normal.


2. Decrease your gluten intake.


Your body can have an inflammatory reaction to very high amounts of gluten. Gluten protein very closely resembles the same type of protein that you find in your thyroid tissue, so in people with a gluten allergy, thyroid disease could be more common.


3. Decrease simple and processed carbohydrates.


Simple carbs are the quickest source of energy such as white and brown sugar. Try to avoid any food or drinks with high sugar content like soda drinks. Processed carbs are a form of sugar and starch that doesn’t exist in the nature and they are manmade such as cake, cookies, muffin, and bread. If the natural types of carbs has been altered in some way that is also considered as processed carbs such as any types of rice and grains that are not in the whole grain form.

4. Take turmeric or curcumin supplement.


Turmeric is a yellow plant from the ginger family that is also used as a spice. Curcumin is a natural compound that comes from turmeric. Curcumin is a very potent antioxidant that offers numerous health benefits such as supporting joint health, liver function, gut health, and cardiovascular efficiency by helping to maintain normal inflammatory response and by shutting down excessive inflammation. It is not very well absorbed, but there are two types of curcumin supplements that have higher absorption:

● Nano curcumin. It means that it was blended into very small particles to make the absorption easier.


● Phyto or phytosome curcumin. Phytosome is a complex natural active ingredients that increases absorption of conventional herbal extracts

● Also taking your curcumin supplement with fatty food and several black peppercorn helps to increase the absorption as well.

5. Take omega 3 fatty acids such as fish oil and krill oil


6. Quit smoking.


Smoking damages your thyroid, studies have shown that smoking increase the chance of either hypo or hyperthyroidism. The most drastic effect of smoking is associated with Grave’s eye disease. Researcher also found that smoking reduces the effect of treatment for thyroid eye disease.