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Can Hashimotos cause blurred vision?

Thyroid eye disease: Symptoms, diagnosis and treatment

Thyroid eye disease is an autoimmune disorder that causes inflammation that damages the fatty tissue, muscles and skin around the eyes. In autoimmune disorders, the immune system mistakenly attacks a healthy part of the body.

Inflammation and swelling from thyroid eye disease often cause the eyes to bulge outward and may lead to symptoms such as eye pain and double vision. The condition can vary from mild to moderate to severe.

There typically are two phases of thyroid eye disease (TED):

  • Active phase – In the active phase, symptoms begin and get worse as tissue damage occurs, usually over a period of six months to two years.
  • Inactive phase – In the inactive phase, disease progress has stopped but some symptoms and eye changes may persist.

It is common for TED to occur along with Graves’ disease, an autoimmune disease that causes excess production of thyroid hormone (hyperthyroidism). For this reason, TED also may be referred to as Graves’ eye disease or Graves’ ophthalmopathy. The term thyroid eye disease is more accurate because the condition also may occur along with other types of thyroid disease.

Causes of thyroid eye disease

Doctors do not fully understand what causes TED. Some patients may have a genetic predisposition to developing it. That doesn’t mean they will develop the disease, but they may if the gene gets “triggered” by other factors.

Several factors are linked with a higher risk of developing TED:

  • Certain health conditions – Patients with conditions such as Graves’ disease, type 1 diabetes or rheumatoid arthritis may be more likely to develop TED.
  • Family history – Patients who have a family member with TED or another autoimmune disease may be more likely to develop it.
  • Smoking – Patients who smoke have a higher risk of developing this disease than non-smokers.
  • Radioactive iodine therapy – This common treatment for hyperthyroidism increases the risk of developing TED.

Women also are more likely than men to be diagnosed with thyroid eye disease, and they make up 86% of all cases, according to the American Academy of Ophthalmology (AAO). TED occurs most commonly in middle-aged women.

As reported in the Review of Ophthalmology, about 80% of patients who develop the condition have an overactive thyroid (hyperthyroid) that produces too much thyroid hormone, such as with Graves’ disease. But about 10% of patients have an underactive thyroid (hypothyroid) that produces too little thyroid hormone. And up to 10% of patients may have normal thyroid function (euthyroid) and no diagnosed thyroid disease.

Eye problems with thyroid disease

It is common for patients with some types of thyroid disease to develop thyroid eye disease. Not all patients will develop eye problems, and the symptoms may vary in severity.

Thyroid eye disease symptoms

The symptoms of thyroid eye disease may become apparent during the active phase of the disease. Symptoms may include:

  • Bulging eyes (proptosis) or exophthalmos
  • Globe luxation (eyes popping out)
  • Double vision (diplopia)
  • Eye pain
  • Eye redness
  • Eyelid swelling
  • Feeling of grit or sand in the eye
  • Sensitivity to light
  • Watery eyes
  • Blurry vision
  • Misalignment of the eyes (strabismus)
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In severe cases, patients may have trouble moving their eyes. In a small percentage of cases (5%), patients may experience vision loss due to compression of the optic nerve.

Some patients also experience cosmetic changes around the eyes such as fat deposits or hollow areas that create shadows under the eyes.

SEE RELATED: Puffy eyes

Frequency of symptoms

The frequency of eye problems associated with TED varies:

  • Eye surface problems that may result in blurry vision, a gritty feeling in the eyes and watery eyes occur in about 90% of patients.
  • Bulging eyes (proptosis) caused by inflammation and swelling of eye tissue occur in about 80% of patients.
  • Misalignment of the eyes (strabismus), along with double vision, occurs in about 50% of patients.

Patients may continue to experience some symptoms, such as bulging eyes and double vision, during the inactive phase of the disease.

The symptoms of TED may resemble the symptoms of other eye problems, so it’s important to see your eye doctor for an exam and diagnosis.

Getting a thyroid eye disease diagnosis

There may be several steps involved in getting a thyroid eye disease diagnosis. It’s important to visit your eye doctor for a comprehensive eye exam as a first step in determining whether your eye symptoms may be related to this condition.

There are several tests that you may need to undergo during the process of getting a diagnosis:

  • Eye measurement – During your eye exam, your eye doctor may use a measuring tool called an exophthalmometer to measure the degree of bulging (orbital proptosis) of your eyes.
  • Imaging – Your health care providers may use a computed tomography (CT) or magnetic resonance imaging (MRI) scan to visualize changes in muscle and fat tissue around the eyes to diagnose the disease.
  • Blood tests – Your doctor may order blood tests to check thyroid function and levels of thyroid hormones to detect hyperthyroidism or Graves’ disease.

In addition to visiting your eye doctor, you may also need to see additional doctors, such as an endocrinologist and/or an ear, nose and throat specialist. At some health centers or hospitals, a multi-specialty team of doctors works together to diagnose and treat TED.

The good news is that once diagnosed, most of the eye problems associated with TED can be treated successfully.

Thyroid eye disease treatment

Treatment will depend on your symptoms and the phase and severity of the disease.

Current thyroid eye disease treatment options include drugs, surgery and an eye patch or special glasses for double vision. If you have Graves’ disease, you’ll need to seek treatment for it as well.

Common treatments that may help alleviate symptoms during the active phase of the disease include:

  • Using lubricating eye drops.
  • Wearing sunglasses.
  • Elevating the head of your bed to help reduce swelling.
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An eye doctor also may prescribe glasses with prism for double vision, though this may not work for all patients.

Drugs for thyroid eye disease

In 2020, the U.S. Food & Drug Administration (FDA) approved a new drug to treat thyroid eye disease. The drug, Tepezza (teprotumumab-trbw), may significantly reduce eye-bulging and may improve or eliminate double vision in TED patients.

Doctors also use corticosteroids such as prednisone to reduce the inflammation and swelling caused by moderate to severe thyroid eye disease. However, steroids generally will not reduce eye-bulging or correct double vision.

Surgery for thyroid eye disease

Surgery is sometimes used to treat moderate to severe cases. Surgery usually is done during the inactive phase of the disease for cosmetic reasons and to treat symptoms such as double vision.

Not all patients will require all types of surgery. Types of surgery may include:

  • Orbital decompression surgery – This type of surgery involves removing fat around the eye (orbital fat) and possibly removing bone around the eye socket to allow the eye to sit further back. Orbital decompression surgery can reduce eye-bulging and prevent vision loss caused by pressure on the optic nerve.
  • Strabismus surgery – This surgery involves releasing tight muscles that result in misalignment of the eyes.
  • Eyelid surgery – Eyelid surgery may correct the retracted eyelids that occur in some patients.
  • Cosmetic surgery or procedures – Some patients seek surgery or other cosmetic procedures for fat deposits or undereye “bags” that result from TED. Instead of surgery, a doctor may be able to use botulinum toxin injections or “fillers” to fix these issues.

Thyroid eye disease may affect patients psychologically due to eye symptoms, vision loss or changes in appearance. For these reasons, patients may need to see a psychologist or other mental health professional for treatment for depression or anxiety related to the condition.

Regular eye exams and thyroid eye disease

Getting regular eye exams helps keep your eyes healthy and allows your doctor to spot any eye changes early. Catching a serious condition such as thyroid eye disease early may help mitigate or prevent serious damage that could result in vision loss.

If you haven’t had an eye exam recently, consider making an appointment with your eye doctor today.

Notes and References

Thyroid eye disease. National Organization for Rare Diseases. Accessed February 2021.

How TEPEZZA can help thyroid eye disease. Horizon Therapeutics. Accessed February 2021.

Graves’ eye disease. American Thyroid Association. Accessed February 2021.

Strabismus in thyroid eye disease. American Academy of Ophthalmology. Accessed February 2021.

Thyroid Eye Disease Clinic. Mayo Clinic. Accessed February 2021.

Graves’ disease. National Institute of Diabetes and Digestive and Kidney Diseases. September 2017.

Page published on Wednesday, February 26, 2020

Does Hashimoto’s affect vision?

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.

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Can thyroid issues cause vision problems?

Many cases are mild and get better as your overactive thyroid is treated, but for around 1 in every 20 to 30 cases there’s a risk of vision loss. If you experience eye problems, you’ll probably be referred to an eye specialist (ophthalmologist) for treatment, such as eye drops, steroid medicine or possibly surgery.

Does Hashimoto’s cause vision loss?

Hashimoto’s/TED takes it several steps further by adding on blurry vision, puffy eyes (also known as periorbital swelling), and loss of eyelash and eyebrow hairs to the list of symptoms.

Can Hashimoto’s thyroiditis affect your eyes?

Conclusion: Eye changes, in particular UER, are common in patients with Hashimoto’s thyroiditis.

Can hypothyroidism make your vision blurry?

Unlike Graves’ thyroid eye disease, where symptoms are overt, eye-related disease symptoms in hypothyroidism are subtle except in severe cases. Swelling may cause blurry vision due to pressure applied to the optic nerve. Similarly, hypothyroidism may cause dry eyes.

Hashimoto’s and Eye Issues

What do hypothyroid eyes look like?

Thyroid eye disease is a condition in which the eye muscles, eyelids, tear glands and fatty tissues behind the eye become inflamed. This can cause the eyes and eyelids to become red, swollen and uncomfortable and the eyes can be pushed forward (‘staring’ or ‘bulging’ eyes).

Can levothyroxine cause vision problems?

In severe cases, levothyroxine may cause the following side effects: Vomiting. Blurred vision. Dizziness.

What is end stage Hashimoto’s thyroiditis?

The end-stage of Hashimoto’s is when your thyroid has become so damaged that you no longer have enough thyroid hormones and have to go on medication.

What are severe symptoms of Hashimoto’s?

Eventually, the decline in thyroid hormone production can result in any of the following:

  • Fatigue and sluggishness.
  • Increased sensitivity to cold.
  • Increased sleepiness.
  • Dry skin.
  • Constipation.
  • Muscle weakness.
  • Muscle aches, tenderness and stiffness.
  • Joint pain and stiffness.

What it feels like to have Hashimoto’s?

Hashimoto’s Thyroiditis is typically characterized by weight gain, fatigue, brittle hair, difficulty concentrating, tiredness, feeling colder than normal, dry and itchy skin, goiters, and my most prominent symptom—depression. At least, that’s the clinical list of symptoms.

What causes Hashimoto’s to flare-up?

Sharma, many people find that grains (specifically gluten -containing grains, like wheat, barley, or rye), high sodium intake, as well as high iodine intake are common triggers for a Hashimoto’s flare-up.

Why is Hashimoto’s getting worse?

Several different things can interfere with your thyroid function or levothyroxine treatment and trigger a flare-up of Hashimoto’s disease, including: Some medications or supplements. Certain dietary nutrients. High stress levels.

Is Hashimoto’s a disability?

Hashimoto’s disease is not listed specifically as a disability. However, thyroid gland disorders are listed under section 9.00 Endocrine Disorders — Adult of the Social Security Act. Unfortunately, it does not give any specific criteria but refers to other impairments to determine whether a person is disabled.

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What are the ocular signs in thyroid eye disease?

The patient complains of gritty sensations, photophobia, lacrimation, dry eye, discomfort, and forward protrusion of the eye. In more advanced cases, patient may complain eye socket (orbital) pain, double vision, or blurred vision.

Can an eye doctor tell if you have thyroid problems?

Which Doctors Diagnose Thyroid Eye Disease? A thyroid eye disease diagnosis often involves a joint effort between an eye doctor, a primary care doctor, and an endocrinologist — a specialist who treats thyroid disease. The eye doctor will ask whether you’ve ever had thyroid problems or have an autoimmune disease.

What do thyroid eyes feel like?

Early symptoms of thyroid eye disease are itching, watering or dry eyes and a feeling of grittiness of the eyes. Some people may notice a swelling around the eyelids and sometimes the front of the eye becomes swollen.

Does Hashimoto’s get worse with age?

Hashimoto’s disease tends to worsen with age because it is progressive. The disease generally progresses slowly over many years and can cause progressive damage to the thyroid glands. Additionally, it is expected that those with Hashimoto’s disease will eventually get hypothyroidism, though this is not always the case.

How many stages of Hashimoto’s are there?

The 5 Stages of Hashimoto’s Thyroiditis — Dr.

Does Hashimoto’s get worse with stress?

Thyroid conditions such as Grave’s disease (hyperthyroid) and Hashimoto’s thyroiditis (hypothyroid) are worsened by chronic stress so learning ways to lessen stress is your key to better health.

What should you not do with Hashimoto’s?

The Autoimmune Protocol (AIP) diet is designed for people with autoimmune diseases. It removes potentially harmful foods like grains, dairy, nightshades, added sugar, coffee, legumes, eggs, alcohol, nuts, seeds, refined sugars, oils, and food additives ( 2 ).

What does an endocrinologist do for Hashimoto’s?

Your endocrinologist or thyroidologist may work with your primary care doctor to manage your condition. For example, if your primary care doctor refers you to an endocrinologist for a diagnosis of Hashimoto’s disease, the endocrinologist may find the right dosage of thyroid hormone replacement for you.

Can you stop Hashimoto’s from progressing?

What’s important to understand here is that these problems are all mediated by your own immune system! As a result, if you can balance or stop your immune system from attacking your own body then you can stop or halt your disease from progressing. This applies 100% to those with Hashimoto’s thyroiditis.

What are 3 side effects of levothyroxine?


  • Chest pain, discomfort, or tightness.
  • decreased urine output.
  • difficult or labored breathing.
  • difficulty with swallowing.
  • dilated neck veins.
  • extreme fatigue.
  • fast, slow, irregular, pounding, or racing heartbeat or pulse.
  • heat intolerance.

What is the downside to taking levothyroxine?

Common side effects of levothyroxine include heat intolerance, a fast heart rate, and diarrhea. More serious levothyroxine side effects are also possible. If you experience side effects like tremors or mood changes, talk to your healthcare provider as soon as you can.

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Why was levothyroxine taken off the market?

The FDA found that the substandard practices could be risky due to inconsistent levels of the active ingredient. Inconsistent levels of medication could lead to risks associated with over- or undertreating hypothyroidism, which the FDA notes “could result in permanent or life-threatening adverse health consequences.”

Hypothyroidism: Symptoms & Signs

Symptoms and signs of hypothyroidism may be subtle and nonspecific, so they may not always clearly signal a thyroid problem. Sometimes, the patient may not notice specific symptoms related to hypothyroidism. Common symptoms of hypothyroidism include fatigue, depression, mild weight gain, cold intolerance, sleepiness, and constipation. Other symptoms can include dry and coarse hair, dry skin, and muscle cramps. Blood cholesterol levels may be elevated. Patients with hypothyroidism may also report aches and pains, swelling in the legs, and difficulty concentrating. Menstrual dysfunction, hair loss, decreased sweating, decreased appetite, mood changes, blurred vision, and hearing impairment are also possible symptoms. Later symptoms (when the condition worsens) can include puffiness around the eyes, slow heart rate, lowered body temperature, and heart failure.

Causes of hypothyroidism

In the U.S., the most common cause of hypothyroidism is an autoimmune disease known as Hashimoto’s thyroiditis. Other common causes include lymphocytic thyroiditis (which may occur after hyperthyroidism), thyroid destruction (from radioactive iodine used as hyperthyroidism treatment or thyroid surgery), and pituitary or hypothalamic diseases.

Related Symptoms & Signs

Other hypothyroidism symptoms and signs

  • Blurred Vision
  • Coarse Hair
  • Cold Intolerance (Increased Sensitivity to Cold)
  • Constipation
  • Decreased Hearing
  • Decreased Sweating
  • Depression
  • Dry Hair
  • Dry Skin
  • Fatigue
  • Forgetfulness (Impaired Memory)
  • Hair Loss
  • Hoarseness
  • Lowered Body Temperature
  • Menstrual Changes
  • Mood Changes
  • Muscle Aches
  • Neck Pain
  • Puffiness Around the Eyes
  • Sleepiness
  • Slow Heart Rate
  • Swelling in the Legs
  • Thyroid Gland Enlargement
  • Trouble Concentrating
  • Weight Gain

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Main Article on Hypothyroidism Symptoms and Signs


Hypothyroidism is any state in which thyroid hormone production is below normal. Normally, the rate of thyroid hormone.


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