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5 Things To Know About Thyroid Eye Disease

Many people with  Graves’ Disease have thyroid eye disease, which is also known as Graves’ ophthalmopathy or Graves’ orbitopathy.   While dealing with Graves’ Disease alone can be scary, it can be even more stressful to experience eye symptoms associated with this condition, including eye swelling, pain, bulging, and double vision. I have written a few other blog posts and articles in the past on thyroid eye disease, but I figured I’d put some of the more important information in this “5 Things To Know” blog post.

1. Like Graves’ Disease, thyroid eye disease is an immune system condition.  Thyroid eye disease involves the immune system attacking the tissues of the eyes.  Most people with moderate to severe eye symptoms will have very high thyroid stimulating immunoglobulins [1].  Since the immune system is the main factor with thyroid eye disease, the primary goal should be to detect and remove the autoimmune trigger.  Below I’ll talk about some conventional and natural anti-inflammatory agents that can help reduce the inflammation associated with thyroid eye disease, but in order to reverse thyroid eye disease you need to detect and remove the autoimmune trigger.

So how do you find and remove the autoimmune trigger?  Well, I’ve discussed this in greater detail in other articles.  But two of the main methods healthcare professionals use are a comprehensive health history [2], along with the proper testing.

2. Radioactive iodine can worsen thyroid eye disease. Numerous studies show that radioactive iodine [3] is associated with an increased risk of thyroid eye disease (1) [4] (2) [5] (3) [6].  It’s important to understand that not only can radioactive iodine treatment exacerbate an existing case of thyroid eye disease, but since many cases of thyroid eye disease are subclinical, receiving radioactive iodine can lead to the development of overt eye symptoms in someone who was previously asymptomatic.  One of these studies showed that taking oral glucocorticoids did not prevent the activation of thyroid eye disease after radioactive iodine (3) [6].  However, intravenous glucocorticoids were effective, although keep in mind that the study was small, involving only nine patients (3) [6].

This doesn’t mean that everyone with thyroid eye disease will experience a worsening of their eye symptoms upon receiving radioactive iodine treatment.  Some people with this condition have received radioactive iodine and didn’t experience any problems.  But since it’s impossible to predict who will do fine, and who will have an exacerbation of their eye symptoms, this isn’t a decision you want to take lightly.

3. Moderate to severe thyroid eye disease isn’t always reversible.  The good news is that most cases of thyroid eye disease are mild or subclinical.  However, some people do experience problems such as exophthalmos, conjunctival edema, or ophthalmoplegia, and a very small percentage experience optic nerve compression.  Can these problems be reversed through natural treatment methods?  It really does depend on the person.  For example, if some has moderate to severe exophthalmos then this might not be completely reversible.  Similarly, surgical decompression is necessary in some people who experience optic nerve compression.

4. High dose natural anti-inflammatory agents can help with the symptoms.  Since inflammation is a big factor in thyroid eye disease, it makes sense to do things that will help to reduce the inflammation associated with this condition.  From a conventional medical standpoint, prednisone is commonly recommended for those with thyroid eye disease.  Although taking a corticosteroid such as prednisone might be required in severe cases of thyroid eye disease that involve optic nerve compression, most people don’t need to take this drug.

Can natural anti-inflammatory agents help to reduce the symptoms associated with thyroid eye disease?  When a patient of mine is dealing with thyroid eye disease I do commonly recommend natural anti-inflammatory agents.  In fact, I commonly recommend natural anti-inflammatory agents to just about all of my patients with Graves’ Disease.  But if someone has moderate to severe eye symptoms then I will get more aggressive.  In other words, I will usually give higher doses of certain supplements and herbs to patients with moderate to severe thyroid eye disease.  I spoke about this in greater detail in a different blog post entitled “What Supplements Can Help With Thyroid Eye Disease? [7]”, but below I’ll also list some of the supplements that can be beneficial in higher doses:

This doesn’t mean you need to take all of these that I listed here.  I recommend for most of my patients to take a fish oil supplement, and I commonly recommend gamma linolenic acid as well, which you can find in borage oil, black currant seed oil, and evening primrose oil.  Getting back to the fish oils, some people question why I don’t recommend another type of omega-3 fatty acid such as cod liver oil or krill oil.  And the reason is because these typically won’t have high enough levels of EPA and DHA to combat the inflammation.  I usually recommend a minimum of 2,000 mg of EPA and 1,000 mg of DHA per day.

There is a lot of research with both turmeric [8]and resveratrol [9]as anti-inflammatory agents.  But once again, larger doses are usually required to help with the symptoms of thyroid eye disease.  For example, someone might need to take 2,000 mg or more of turmeric in the form of a curcumin supplement.  You also want to make sure you have healthy levels of vitamin D.  I recommend for lab values to be at least 50 ng/mL (125 nmol/L), and between 60 and 80 ng/mL might be even more beneficial.

Keep in mind that taking high doses of these anti-inflammatory agents alone frequently isn’t sufficient to completely eliminate the symptoms of thyroid eye disease.  As I mentioned earlier, you also must detect and then remove the autoimmune trigger.  This is also the case with corticosteroids such as prednisone, as these drugs don’t do anything to address the cause of the problem.

5. There is a good amount of research involving selenium and thyroid eye disease.  I’m not going to discuss this in detail, as I have written a separate article on this entitled “Can Taking Selenium Help To Reverse Thyroid Eye Disease? [10]”  But the way selenium [11]seems to help is by reducing oxidative stress that is associated with thyroid eye disease.  And the way it accomplishes this is by forming selenoproteins, which are powerful antioxidants.  Many reading this are familiar with glutathione, which is an antioxidant that is dependent on these selenoproteins.  So if you have a selenium deficiency, this will result in low levels of selenoproteins, along with low glutathione levels, which can be very problematic in someone who has a lot of oxidative stress.

You might wonder if you can help to reduce oxidative stress by taking a glutathione supplement.  The answer is “yes”, as taking an acetylated or liposomal form of glutathione can help to reduce the oxidative stress associated with thyroid eye disease.  However, since healthy selenium levels are required for healthy glutathione levels, it’s important to make sure you have sufficient selenium levels as well.  But since selenium toxicity is a concern you don’t want to take too high of a dosage of selenium, which I discuss in greater detail in the separate article I wrote on selenium and thyroid eye disease.

Should You Choose A Natural Treatment Approach?

After reading this blog post you might not be sure if taking a natural treatment approach is the best option for your thyroid eye disease condition.  After all, I mentioned how taking natural anti-inflammatory agents and selenium can help, but I also explained the importance of detecting and removing the autoimmune trigger.  And so it can be challenging to overcome thyroid eye disease naturally.

However, I do think that most people with thyroid eye disease should consider taking a natural treatment approach.  And the reason for this is because the conventional medical treatment methods don’t do anything to address the underlying cause of the condition.  So for example, if you choose to receive radioactive iodine or a thyroidectomy, not only is there a chance that your thyroid eye disease symptoms can worsen (especially with RAI), but neither of these procedures will do anything to improve the health of your immune system.  And as I have mentioned in previous blog posts and articles, the research clearly shows that someone with one autoimmune condition is more likely to develop other autoimmune conditions in the future.

So hopefully you have a better understanding of thyroid eye disease.  Just remember that this is an immune system condition, and so while it’s understandable to do things to help manage the eye symptoms, it’s also necessary to address the autoimmune component.  And while conventional medical treatment methods sometimes are necessary, hopefully you’ll consider trying some of the natural treatment options I discussed in this blog post.  But in addition to using natural anti-inflammatory agents and selenium to help manage the symptoms, you also want to do everything you can to detect and remove the autoimmune trigger.