Hypothyroidism Insomnia: How it Can Be Treated

The eye changes associated with Graves’ disease can be called either Graves’ ophthalmopathy, Graves’ orbitopathy, or Graves’ eye disease. Approximately 50% of the patients with Graves’ disease develop some eye disease, but the eye changes may be so subtle that patients are unaware of them. For most patients with Graves’ disease, eye involvement is minimal. Severe orbitopathy occurs in less than 5% of patients with Graves’ disease.

Graves’ eye disease is not caused by thyroid dysfunction. Graves’ disease is an autoimmune disease that affects the eyes and the thyroid gland independently of each other. Thus, the hyperthyroidism may improve with therapy, while the eye disease stays the same or gets worse. Even though the thyroid disease and the eye disease run independent courses, it is important to treat the hyperthyroidism associated with Graves’ disease.

An ophthalmologist is usually involved in the treatment of Graves’ eye disease. Most thyroidologists and endocrinologists should be able to recommend an ophthalmologist experienced in the treatment of Graves’ eye disease. In addition, The Thyroid Society maintains a list of such ophthalmologists throughout the country.

Symptoms of Graves’ eye disease may include a feeling of irritation or sand in the eyes, double vision (diplopia), and excessive tearing. Inflammation and swelling behind the eye may cause actual protrusion of the eyeball from the orbit. When this protrusion occurs, it is called exophthalmos or proptosis.

When the eye changes are severe, there may be marked swelling of the eye, inability to move an eye, corneal ulceration, and in extreme cases, loss of vision. Fortunately, these severe changes occur infrequently, but when they do occur, consultation with an ophthalmologist is essential. Graves’ eye disease usually affects both eyes, although each eye may be affected to a different degree. In some cases, only one eye is affected.

The course of Graves’ eye disease is unpredictable. The initial, or active, phase of Graves’ eye disease may last for eighteen to twenty-four months. During this time period, the eye signs and symptoms may change considerably. For this reason, physicians are reluctant to use certain treatments, such as surgery, during this phase, fearing that ongoing inflammation will cause the eyes to change again after surgery. Thus, most physicians advise patients to defer treatments such as surgery until the eye disease goes into an inactive phase. Of course, if a patient’s symptoms are severe or if loss of vision is threatened, then all available treatments will be used at any time, even during the active phase.

Most patients will receive only symptomatic treatment during the active phase of Graves’ eye disease (see list below). Most importantly, it should be stressed that smoking aggravates Graves’ eye disease.

Physicians may advise the following to relieve symptoms associated with Graves’ eye disease:

• discontinue smoking
• avoid smoke-filled rooms
• use lubricating eye drops
• cover eyes while sleeping
• wear wrap-around dark glasses outdoors during the day
• elevate the head of the bed to reduce overnight eye swelling
• wear prism glasses, or cover one eye with a patch, to relieve double vision
• turn ceiling fans off before going to bed
• avoid exposure to strong sunlight
• avoid or limit wearing contact lenses
• take diuretics temporarily to relieve swelling around the eyes

When symptoms of inflammation are severe, either steroids in large doses or radiation therapy may be advised. Surgery (orbital decompression) is sometimes recommended when the inflammation is so severe that loss of vision is threatened. The choice of therapy among steroids, radiation, and surgery (used individually or in combination) and the timing of therapy require a great deal of thought on the part of the team caring for the patient with Graves’ eye disease.

Once the inflammation in the eyes has stabilized, or entered the inactive phase, patients may then have surgery to relieve signs and symptoms, such as lid retraction, swelling around the eyes, or double vision. Ophthalmologists specializing in plastic surgery of the eye perform the surgery to relieve lid retraction and swelling around the eyes. Sometimes other ophthalmologists who specialize in diseases of the muscles of the eye perform the operation(s) to relieve double vision.

Medical and Surgical Treatment Options for Graves’ Eye Disease

• steroids
• radiation therapy
• surgical adjustment of eyelid placement
• plastic surgery for swelling around the eye(s)
• eye muscle surgery for realignment of the eye(s)
• orbital decompression

Thyroiditis is an inflammation of the thyroid gland. Thyroiditis can cause either hyperthyroidism or hypothyroidism, or one followed by the other. It can also cause a goiter, an abnormal swelling in the neck due to an enlarged thyroid. It affects about 12 million people in the United States.

Thyroiditis is the most common cause of hypothyroidism. When patients with thyroiditis have any symptoms, they are usually the symptoms of hypothyroidism. It is also common to have an enlarged thyroid that may shrink over time.

The type of thyroiditis seen most often is Hashimoto’s thyroiditis, a painless disease of the immune system that runs in families. Hashimoto’s thyroiditis affects about 5% of the adult population, increasing particularly in women as they age.

Another form of thyroiditis affects women of childbearing age. Postpartum thyroiditis occurs in 5%-9% of women soon after giving birth and is usually a temporary condition.

Viral and bacterial infections can also cause thyroiditis.

Graves’ disease is the most common form of hyperthyroidism. It affects many Americans, including Olympic athlete Gail Devers, who won a gold medal in track after being diagnosed with and treated for Graves’ disease.

Graves’ disease is caused by problems with the immune system. Normally, the immune system defends the body against germs and viruses. In autoimmune diseases such as Graves’, the immune system attacks the body’s own tissues. In Graves’ disease, the body produces antibodies which make the thyroid gland produce too much thyroid hormone.

Diseases of the immune system tend to run in families and are about five times more common in women. Graves’ is linked to other autoimmune conditions, such as Hashimoto’s thyroiditis, premature gray hair, diabetes mellitus, arthritis and patchy loss of skin pigment (vitiligo).