There are two basic types of Graves’ ophthalmopathy, (also called thyroid eye disease or TED). The more common type is caused by abnormal levels of thyroid hormone and resolves as levels improve. This subtype usually causes spastic symptoms such as staring, dryness, twitching, and lid lag.

The second type of TED is autoimmune, runs its own course independent of the thyroid condition, is likely to also cause congestive, inflammatory changes, and resolves within several months to several years.

Risk Factors for Congestive TED

Certain factors increase the risk of developing autoimmune TED, including cigarette smoke, radioiodine ablation, very high levels of TSH receptor antibodies, low levels of TPO antibodies, low selenium levels, excess dietary iodine in fast and processed foods, sudden moves into hypothyroidism related to treatment, stress, diet, and genetic factors.

Preventive Measures

The anti-thyroid drugs methimazole, carbimazole, and propylthiouracil (PTU) are mild immunosuppressants and offer protection against TED. The FT4 level should be used to monitor drug therapy. FT4 should not be allowed to fall too low regardless of the TSH level. Hypothyroidism causes the gland to speed up its activity, which includes increased thyroid antibody production, increasing TED risk.

Avoid: cigarette smoke; excess dietary iodine in fast and processed foods and dairy products; low selenium levels; aspartame; and other known risk factors for Graves’ disease.

Avoid: sugar, saturated fats, and known or suspected allergens; they promote inflammation. Note: because many people with autoimmune thyroid disease have gluten sensitivity, it’s best to avoid wheat.

Avoid radioiodine ablation. Studies suggest that administering corticosteroids to patients receiving radioiodine minimizes the risk of TED. However, corticosteroids are generally not recommended because of their side effects and there are no long-term studies showing how long corticosteroids offer protection. Corticosteroids are usually given for several weeks and the risk for developing TED after RAI lasts for more than 30 years.

Antioxidant vitamins, anti-inflammatory herbs and bioflavinoids reduce inflammation and help modulate the immune system. A nutrient-rich diet, adequate water, and a stress reduction production are all known to help the healing process in TED.