Puffy Around Eyes From Hyperthyroidism

Managing thyroid eye

The thyroid gland is a butterfly-shaped gland present in the front of the neck and secretes the thyroxin hormone, which is responsible for maintenance of the normal metabolic activities of the human body. But when present in abnormally high quantities it can cause various adverse side effects as a result of the increased rate of metabolism.

Paradoxically the thyroid gland and the muscles, which move the eyes (extra-ocular muscles), share a common antigen and the antibodies that attack the thyroid gland also attack the extra-ocular muscles resulting in swelling of the muscles and the surrounding fat tissues. As the bony orbit that encases the eye cannot expand to accommodate the sudden increase in volume, the eye is pushed forward giving the affected person a “staring look”.

Changes in the eye

This condition in which the eyes are affected by the underlying thyroid condition is called Thyroid Related Ophthalmopathy (TRO) or Graves Ophthalmopathy. Usually the patient presents with eye changes first following which the underlying hyperthyroid condition is diagnosed. The eyes usually become red (congested) and irritable and the patient feels a sense of tightness behind the eyes. The eyes become prominent (Proptosis) and the lids are puffed up. If the condition is left untreated it can result in the patient experiencing double vision (Diplopia); in rare cases, the enlarged muscles press on the optic nerve, which takes the visual impulses from the eye to the brain, and can result in blindness.

The first step in managing this condition lies in performing appropriate blood investigations to detect levels of circulating thyroid hormones and presence of anti-thyroid antibodies. A routine eye examination to check vision, colour vision, field of vision and eye pressure and extra-ocular movements is done. Imaging studies like ultrasound or CT scan may also be required to find out whether the eye muscles are enlarged.

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