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Rheumatoid Arthritis and Thyroid Eye Disease: What’s the Connection?

Medically reviewed by Prakruthi Jaladhar, M.D., DNB
Written by Sarah Winfrey
Posted on June 21, 2024

Sometimes, people who live with one autoimmune disease, like rheumatoid arthritis (RA) end up being diagnosed with other diseases where the immune system attacks the body. For example, people with RA might also be diagnosed with thyroid problems.

Autoimmune thyroid disease can cause eye issues, which may be part of thyroid eye disease (TED). RA can cause eye symptoms like dryness, redness, pain, loss of vision, or a decreased ability to see. If you have TED along with RA, it can make eye problems more serious and require immediate attention. Here’s what you need to know if you think you have a thyroid problem or if you’ve been diagnosed with one.

Rheumatoid Arthritis and Thyroid Problems

People who are already diagnosed with RA have a higher chance than others of also being diagnosed with thyroid problems. They are most likely to be diagnosed with hypothyroidism, where their thyroid doesn’t produce enough thyroid hormones. However, they are also more likely than those without RA to be diagnosed with hyperthyroidism, where the thyroid produces too much thyroid hormones.

Many thyroid problems are caused by autoimmune issues. Autoimmune thyroid diseases may share causes in common with RA. Of all the autoimmune thyroid diseases, the one that usually causes TED is called Graves’ disease. Graves’ disease causes between 60 percent and 80 percent of all hyperthyroidism, too. Having a diagnosis of either RA or Graves’ disease puts you at a higher risk of eventually being diagnosed with the other one.

In addition, some studies show that people with active RA or more severe RA are more likely to also have thyroid problems.

Several myRAteam members have found out that they have both RA and Graves’ disease. One said, “My doctor discovered Graves’ while doing bloodwork for RA.”

Occasionally, having one may complicate getting an accurate diagnosis for the other, as it did for someone who shared, “I believe that is why it took so long to diagnose RA.”

Graves’ Disease and Thyroid Eye Disease

Graves’ disease can affect many parts of the body, including the bowels, the reproductive system, the skin, the heart, and more. One myRAteam member shared, “Just found out that the Graves’ disease I got following about 15 years of rheumatoid arthritis has caused damage to my heart.”

Approximately 30 percent of people diagnosed with Graves’ disease will have it affect their eyes. This is called thyroid eye disease. It may also be called Graves’ ophthalmopathy, Graves’ orbitopathy, or Graves’ eye disease.

In TED, the fat and muscles behind the eye become inflamed. This inflammation is a direct result of the immune system not working properly.

TED can be complicated. While the condition is usually caused by Graves’ disease, occasionally, it also happens to people who have been diagnosed with hypothyroidism.

Symptoms of Thyroid Eye Disease

People diagnosed with TED will often have eyes that seem to bulge out of their sockets. However, there are other common symptoms, like:

  • Red eyes
  • Inflamed eyes
  • Eye pain
  • Pressure in or around the eyes
  • A gritty sensation, or the feeling that there’s something in the eye
  • Eyelid changes, like puffing up or retracting
  • Seeing double
  • Loss of vision
  • Increased sensitivity to light
  • Difficulty closing an eye all the way
  • Problems moving an eye around in its socket

Most of the time, TED will involve both eyes at the same time. Some people only experience symptoms in one eye, though. Many find that their symptoms eventually go away on their own, although a few experience long-term vision problems caused by complications from TED.

Other Symptoms of Graves’ Disease

Graves’ disease can have symptoms beyond the eyes or in addition to eye problems. Many people find that their skin gets thick and/or discolored, especially on the top of the foot or the shin. Other indications that you should look into Graves’ disease include:

  • An enlarged thyroid gland
  • Changes in menstrual cycles, libido, or the ability to get an erection
  • Increased fatigue, anxiety, or irritability
  • Heart palpitations
  • Tremors in the hands and/or fingers
  • New or increased problems sleeping
  • Increased sensitivity to heat or increased sweating
  • Weight loss without trying
  • More frequent bowel movements

If you experience these symptoms, especially if you notice them in addition to symptoms of TED, it’s time to talk to your rheumatologist or an endocrinology expert about Graves’ disease. They should be able to test you for it and get an accurate diagnosis.

Treatments for Graves’ Disease and the Thyroid

Treating Graves’ disease involves stopping the thyroid from producing too many hormones or blocking those hormones from affecting the body. Your rheumatology team or endocrinologist may have you take radioactive iodine to destroy the thyroid cells that are producing the hormones. They may also have you take medications that limit thyroid function or beta-blockers, which block thyroid hormones from affecting the body. Sometimes, thyroid surgery is the best way to treat Graves’.

If your thyroid is underactive, you’ll need to take medication to give your body the hormones it needs.

Treatments for Thyroid Eye Disease

Your doctor may also give you treatments specifically for your eyes. The treatment of TED is based on how severe your symptoms are. Treatment includes local measures (treatments applied directly to the eye), medical measures, and surgical measures. Treatment options for TED include:

  • Additional lubrication for your eyes, in the form of gel or tears
  • Corticosteroids (steroids)
  • Teprotumumab (Tepezza)
  • Surgical procedures

You may need a combination of these treatments to protect your vision and improve TED. In addition, your doctor may recommend that you quit smoking or add selenium supplements to your diet to see if that helps your symptoms.

Talk to Your Doctor if You Suspect Thyroid Problems

If you think you have thyroid problems or if you’re experiencing TED symptoms, talk to your health care provider right away. They should be able to offer medical advice and order any testing you need.

Once you know what is going on with your eyes, your health care team can help you find a treatment that will work for you.

Find Your Team

On myRAteam, the social network for people with RA and their loved ones, more than 205,000 members come together to ask questions, give advice, and share their stories with others who understand life with rheumatoid arthritis.

Are you concerned about thyroid eye disease alongside rheumatoid arthritis? Share your experience in the comments below, or start a conversation by posting on your Activities page.

    Posted on June 21, 2024
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    Prakruthi Jaladhar, M.D., DNB completed her medical education at Mysore Medical College, followed by an internal medicine residency at Kempegowda Institute of Medical Sciences (KIMS) in Bangalore. Learn more about her here.
    Sarah Winfrey is a writer at MyHealthTeam. Learn more about her here.

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