Thyroid Eye disease (TED for short), also known as Graves' ophthalmopathy or Graves' orbitopathy is an autoimmune condition.
TED affects between 25 and
50 % of people who have Graves’ disease, but it can also occur with Hashimoto’s thyroiditis.
Sometimes, TED is the first sign of any thyroid problem. However, higher thyroid levels won’t necessarily cause a more severe case.
Symptoms of Thyroid Eye Disease
Most of the time, Graves’ eye disease affects both eyes. About 15 percent of the time, only one eye is involved. The active (flare) stage of thyroid eye disease can last from 6 months to 2 years. Treatments can help shorten this phase.
TED isn’t directly linked to high thyroid levels. There’s no connection between your eye symptoms and the severity of your hyperthyroidism.
Symptoms of TED may include:
dry eyes, grittiness, irritation
eye pressure and pain
redness and inflammation
bulging of the eyes, also called exophthalmos
aching or discomfort in the eye when looking to the side or upwards
In severe cases, you might have trouble moving or closing your eyes, ulceration of the cornea, and compression of the optic nerve. TED can lead to loss of vision, but this is rare.
Symptoms generally start around the same time as other symptoms of Graves’ disease, but some people develop eye symptoms first. Rarely does TED develop long after treatment for Graves’ disease. It’s also possible to develop TED without having hyperthyroidism. Graves' disease includes symptoms such as:
unintended weight loss
an abnormal intolerance of heat
protrusion or bulging of the eyeballs from their sockets
Treatment of TED
Treating Graves’ disease involves certain therapies to keep hormone levels within the normal range. Graves’ eye disease requires its own treatment, since treating Graves’ disease doesn’t always help with eye symptoms.
There’s a period of active inflammation in which symptoms worsen. This can last up to six months or so. Then there’s an inactive phase in which symptoms stabilize or start to improve.
There are quite a few things you can do on your own to ease symptoms, such as:
Eye drops to lubricate and relieve dry, irritated eyes. Use eye drops that don’t contain redness removers or preservatives. Lubricating gels can also be helpful at bedtime if your eyelids don’t close all the way. Ask your doctor which products are most likely to help without irritating your eyes further.
Cool compress to temporarily relieve irritation. This may be especially soothing just before you go to bed or when you first get up in the morning.
Sunglasses to help protect against light sensitivity. Glasses can also protect you from wind or breezes from fans, direct heat, and air conditioning. Wraparound glasses may be more helpful outdoors.
Sleep with your head raised to reduce swelling and relieve pressure on the eyes.
Corticosteroids such as hydrocortisone or prednisone can help reduce swelling. Ask your doctor if you should be using corticosteroids.
Don’t smoke, as smoking can make matters worse. If you smoke, ask your doctor about smoking cessation programs.
Acupuncture & Chinese herbs
Gluten and your thyroid
There is a higher incidence of Celiac disease in people who have thyroid disease than there is in the general population. This may be due, in part, to a genetic link. Foods containing gluten may make treatment more difficult for people with autoimmune thyroid diseases, including Graves’ disease. Many foods and drinks contain gluten. It’s important to read labels and to look for gluten-containing ingredients. These include:
wheat and wheat products
rye, barley, malt (think Beer !)
grains of all kinds such as spelt, kamut, farro, and durum
some fillers used in medications are wheat based
What to eat and what to avoid
Dietary iodine: avoid
There is some evidence that iodine intake might trigger hyperthyroidism in older adults or people who have a preexisting thyroid disease. Iodine rich or fortified foods include:
dairy products, such as milk, cheese, and yogurt
seafood, especially white fish, such as haddock, and cod
seaweed, and other sea vegetables, like kelp
Meat and other animal products: avoid
One study found evidence that rates of hyperthyroidism were lower in those who follow vegetarian diets. It also concluded that there was the greatest benefit in people who avoided all animal products, including meat, chicken, pork, and fish.
A deficiency in selenium is associated with TED in people with Graves’ disease. This can cause bulging eyeballs and double vision. Selenium is an antioxidant and a mineral that can be found in:
brazil nuts & sunflower seeds
Acupuncture & thyroid
A 2018 overview of research found acupuncture to be promising for thyroid conditions. Similarly, the British Acupuncture Council cites a number of ways in which acupuncture has been found to be useful for treating thyroid disease, such as:
Increasing levels of thyroid hormones in the people with hypothyroidism
Lowering levels of thyroid hormones in patients with hyperthyroidism
Reducing sensitivity to pain and stress
Improving muscle stiffness and joint mobility by increasing blood circulation in small blood vessels, which aids dispersal of swelling
Reducing inflammation by promoting the release of vascular and immuno-modulatory factors
A study into Graves ophthalmopathy concluded that a Chinese herbal preparation was capable of inhibiting pre-adipocyte proliferation and enhancing adipocyte apoptosis (link). This means this particular formula reduces the adipose content within the eyeball which is partially responsible for the protrusion.
No matter what your condition is, DO NOT self medicate with Chinese herbs, and do not stop your thyroid medication without talking to your general practitioner.
Talk to your acupuncturist today to balance your thyroid!
No matter where you are in your eye health journey,
if you need support, we can help.
In addition to our own team of specialized acupuncturists, we are well-connected within the Los Angeles- Pasadena area community to help you
find the right integrative and holistic care for you.
If you have more questions please call our front desk, at 626-841-2991, or email us.
Xu WM, Guo YH, Chen BX. [Efficacy observation on infiltrative exophthalmos treated with acupuncture and acupoint massage]. Zhongguo Zhen Jiu. 2011 Feb;31(2):101-4. Chinese. PubMed PMID: 21442804. 9. Zhang SJ, Li SR, Li JS, Liu J, Song RX. [Clinical observation on acupuncture for treatment of paralytic strabismus]. Zhongguo Zhen Jiu. 2009 Oct;29(10):799-803. Chinese. PubMed PMID: 19873915.
Kuang Ankun, et al., Effect of traditional Chinese medicine on primary hypothyroidism in relation to nuclear T3 receptors in lymphocytes, Chinese Journal of Integrated Traditional and Western Medicine 1988, 8(11).