[Anonymous]

#1153783

Hi, Clementine! The short answer to your question is that eyelid
retraction is a common symptom of hyperthyroidism and *could be* one
of the first stages of Graves’ Ophthalmopathy.

Here’s the long answer with sources listed:

“Your Thyroid – A Home Reference” (Wood, Cooper, Ridgway): Elevation
of the upper eyelids may be seen in anyone who has a high level of
thyroid hormone, even someone who is taking thyroid hormone tablets
in excess. The other things that can happen to your eyes in GD are
unrelated to your blood level of thyroid hormone. If you are one of
the people with GD who develops eye inflammation and protrusion, the
eye problems will probably begin when you first become hyperthyroid.
Quite often, however, eye problems and thyroid overactivity occur at
different times, occasionally separated from one another by many years.
Very rarely a person may develop eye trouble as the only manifestation
of GD. Eye disease is therefore one problem that occurs only in the
type of hyperthyroidism that is caused by GD. (page 33)

TFA “The Bridge” Newsletter via Bobbi: One of the main eye changes that
occurs, and one which is almost completely due to the hyperactive state,
is an elevation of the upper eyelid (called eyelid retraction), which
gives us that “stare” look and makes the eyes appear bigger. Lid
retraction may give a false impression of eye protrusion, and can cause
symptoms of eye dryness and irritation from excessive exposure to the
air… After the hyperthyroidism has been treated, eyelid retraction
usually resolves, although 10% to 15% of Graves’ patients also develop
Class II and Class III eye disease.

TFA “The Bridge” Newsletter via Bobbi: The categories of eye changes
with Graves’ Disease using a mnemonic device: NO SPECS.

N o signs or symptoms
O nly signs are lid retraction
S oft tissue changes (irritation, light sensitivity, puffiness)
P roptosis (exopthalmos, bulging)
E xtraocular muscle problems (i.e. double vision)
C orneal problems (exposure of the front of the eye due to failure
to close the lids at night)
S ight (loss of vision due to pressure on the optic nerve)

The changes do NOT necessarily progress in sequential order, nor do
they all necessarily occur in a patient with Graves’ disease. Bulging
eyes may be present with minimal soft tissue changes. Double vision
may be an isolated or dominant problem. This classification is important
only because it allows us to ask which problem is troubling the patient,
rather than just saying “the eyes are bad.”

NGDF Bulletin #11: The treatment of this initial stage of thyroid eye
disease is directed primarily at reducing inflammation and keeping the
eyes moist (i.e., artificial tears during the day, lubricant at night,
elevated bed, decreasing salt in the diet, possible steroid meds).

There’s more, but I’ll call this info enough for now. BTW, lid
retraction was *my* first symptom of Graves’, then the doctors
discovered my overactive thyroid.

Wishing you health and happiness, Debby

[Anonymous]

#1052355

Hi Debbie, the info you provided is very useful. However, I wish to seek one further clarification.

Is the upper eyelid elevation considered as a Thyroid related eye disease or rather just a symptom of Hyprthyroidism (when it is the only eye involvement present in the patient) ?

Thanks.

[Anonymous]

#1153784

Thank you Bobbi.
I just have so many questions because I haven’t had a chance to see the endo and I don’t until this Monday. I’m so nervous.
My eyes aren’t noticeably red to anyone. I just have a few red lines here and there that I can only notice if I look really close in the mirror. To me, my right eye looks a little bigger than my right eye, but my husband swears up and down that it has always been like that. Looking back at pictures from when I was 14 even, it looks like he’s right.
It sounds like I should expect to have some type of eye problems at some point in my disease, but perhaps it will be mild and only last a few months to a year or so and probably go away on my own. I think I can deal with that. It is only is the rare cases that it gets severe, correct?
I’ve met and spoken with several people (8 or so) that have had Grave’s in the past year or two and none of them mentioned anything about eye problems. My general practitioner told me he has only seen it twice in his career! Do you think he is just trying to get me not to worry about it since there is nothing I can do about it anyway? If I do get the eye problem, would treatment of it prevent me from trying to get pregnant in the next year? Also, are the eye problems hereditary? My aunt and grandma on my dad’s side had graves, and they never had any eye problems.
Concha

[Anonymous]

#1153785

I do not think your doctor was trying to make you feel better. Bad eye disease is not common, so it is entirely possible that your doc has only seen two cases of it. I have “some” eye disease and my endo keeps telling me I have had the “worst” case of Graves’ that she has ever seen.

Is it hereditary? I don’t think anybody knows for sure.
Bobbi — NGDF Online Facilitator

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