What is the Difference Between Graves Disease and Thyroid Eye Disease

The immune system is a complex mechanism designed to detect and eliminate foreign threats. However, many immune disorders arise from an exaggerated immune response or an autoimmune attack. Graves’ disease and thyroid eye disease are two such distinct autoimmune conditions.

The key difference between Graves disease and thyroid eye disease is their cause. Graves’ disease is caused by the immune system attacking the thyroid gland, while thyroid eye disease is caused by the immune system targeting the muscle and fat tissue behind the eyes.

CONTENTS

1. Overview and Key Difference
2. What is Graves Disease 
3.  What is Thyroid Eye Disease
4. Similarities – Graves Disease and Thyroid Eye Disease
5. Graves Disease vs Thyroid Eye Disease in Tabular Form
6. Summary – Graves Disease vs Thyroid Eye Disease
7. FAQ: Graves Disease and Thyroid Eye Disease

What is Graves Disease?

Graves’ disease is an immune system disorder due to the overproduction of thyroid hormones. In Graves’ disease, the immune system produces antibodies that target cells in the hormone-producing gland in the neck. One specific antibody involved is called thyrotropin receptor antibody (TRAb). TRAb disrupts the normal regulation of the thyroid, leading to an excessive production of thyroid hormones.

Common signs and symptoms of Graves’ disease include anxiety, irritability, fine tremors of the hands and fingers, sensitivity to heat, weight loss, goiter, changes in menstrual cycle, erectile dysfunction, frequent bowel movements, bulging eyes, fatigue, thick and red skin, typically on the shins or tops of the feet, palpitations, and sleep disturbances. Risk factors for this condition include family history, sex (women are more affected), age (typically occurring before age 40), other autoimmune disorders, emotional or physical stress, pregnancy, and smoking.

Graves disease can be diagnosed through physical examination, blood test, radioactive iodine uptake, ultrasound, CT scan, and MRI. Furthermore, the treatment options for Graves disease may include radioactive iodine therapy, antithyroid medications, beta-blockers, and surgeries like thyroidectomy.

What is Thyroid Eye Disease?

Thyroid eye disease is an autoimmune disorder in which the eye muscle and fatty tissue behind the eye become inflamed. With thyroid eye disease, the immune system of the body mistakenly sends out antibodies that attack the fat, muscle, and other tissue in and around the eye. The risk factors for thyroid eye disease are female sex, cigarette smoking or exposure to secondhand smoke, history of radioactive iodine treatment for thyroid dysfunction, older age (between 40s and 60s), stress, and uncontrolled thyroid disease. The signs and symptoms of thyroid eye disease are dry eyes, irritated eyes, watery eyes, red eyes, bulging eyes, a stare, double vision, difficulty closing the eyes completely, pain behind the eyes, and pain with eye movements.

Thyroid eye disease can be diagnosed through physical eye examination, ultrasound of the eye, CT scan, and MRI imaging. Furthermore, treatment options for thyroid eye disease are eye drops to relieve dryness and irritation, taking selenium supplements, drinking aloe vera juice to reduce inflammation levels, taking anti-inflammatory drugs like prednisone and other systemic steroids/or rituximab, taking a new medicine available only for thyroid eye disease called teprotumumab, lifestyle and home remedies like using cool compresses on your eyes, wearing sunglasses, keeping the head higher than the body when you lie down, using a patch on one eye to reduce double vision, etc. and eye surgery.

What are the Similarities Between Graves Disease and Thyroid Eye Disease?

• Graves’ disease and thyroid eye disease are two different autoimmune diseases.
• Both conditions show similar symptoms, such as bulging of eyes.
• Both conditions can be diagnosed through physical evaluation and imaging tests.
• They can be treated through specific medications and surgeries.

Comparing the Difference Between Graves Disease and Thyroid Eye Disease

Definition

1. Graves’ disease is an immune system disorder that is due to the overproduction of thyroid hormones.
2. Thyroid eye disease is an autoimmune disorder in which the eye muscle and fatty tissue behind the eye become inflamed.

Causes

1. In Graves’ disease, TRAb overrides the normal regulation of the thyroid, causing an overproduction of thyroid hormones.
2. In thyroid eye disease, the immune system of the body mistakenly sends out antibodies that attack the fat, muscle, and other tissue in and around the eye.

Risk Factors

1. The risk factors for Graves’ disease include family history, sex (women affected more), age (likely to get before 40), other autoimmune disorders, emotional or physical stress, pregnancy, and smoking.
2. The risk factors include female sex, smoking or exposure to secondhand smoke, history of radioactive iodine treatment for thyroid dysfunction, older age (between 40s and 60s), stress, and uncontrolled thyroid disease.

Signs and Symptoms

1. Signs and symptoms of Graves’ disease include anxiety and irritability, a fine tremor of the hands and fingers, heat sensitivity, weight loss, goiter, change in the menstrual cycle, erectile dysfunction, frequent bowel movements, bulging eyes, fatigue, thick, red skin normally on the shins or tops of the feet, palpitations, and sleep disturbances.
2. Signs and symptoms of thyroid eye disease include dry eyes, irritated eyes, watery eyes, red eyes, bulging eyes, a stare, double vision, difficulty closing the eyes completely, pain behind the eyes, and pain with eye movements.

Diagnosis

1. Graves’ disease is diagnosed by physical examination, blood test, radioactive iodine uptake, ultrasound, CT scan, and MRI.
2. Thyroid eye disease is diagnosed by physical eye examination, ultrasound of the eye, CT scan, and MRI imaging.

Treatment

1. 1. Treatment options for Graves’ disease include radioactive iodine therapy, antithyroid medications, beta-blockers, and surgeries like thyroidectomy.
   2. Treatment options for thyroid eye disease include eye drops to relieve dryness and irritation, taking selenium supplements, drinking aloe vera juice to reduce inflammation levels, taking anti-inflammatory drugs,  taking a new medicine like teprotumumab, lifestyle and home remedies like using cool compresses on your eyes, wearing sunglasses, keeping the head higher than the body when you lie down, using a patch on one eye to reduce double vision, etc. and eye surgery.

The infographic below presents the differences between Graves disease and thyroid eye disease in tabular form for side-by-side comparison.

Summary – Graves Disease vs Thyroid Eye Disease

Immune system or autoimmune disorders occur when the immune system attacks the body’s own cells. Graves disease and thyroid eye disease are two distinct autoimmune conditions, with thyroid eye disease often associated with Graves disease. However, Graves’ disease involves the immune system attacking the thyroid gland, while thyroid eye disease targets the muscle and fat tissue behind the eyes. Additionally, Graves’ disease affects the thyroid gland, eyes, and skin, whereas thyroid eye disease solely impacts the eyes. Thus, this summarizes the difference between Graves disease and thyroid eye disease.

FAQ: Graves Disease and Thyroid Eye Disease

1. What are the first signs of thyroid eye disease?

1. 1. • The first signs of thyroid eye disease are bags under the eyes, blurred/double vision, change of the eyes’ appearance (usually staring/bulging), difficulty moving the eyes, dry or watery eyes, gritty feeling in the eyes, low tolerance of bright lights and pain in or behind the eye especially when looking up, down, or sideways.

2. Can you have Graves disease without thyroid eye disease?

1. 1. • Thyroid eye disease often develops in individuals with Graves’ disease. However, approximately 1 in 10 people with thyroid eye disease have developed the condition without having Graves’ disease.

3. Is thyroid eye disease related to hyperthyroidism?

1. 1. • Around 90% of patients with thyroid eye disease also suffer from hyperthyroidism. Additionally, most patients with Graves disease exhibit some signs of thyroid eye disease. Both of these conditions stem from the same underlying autoimmune process.

4. What can be mistaken for thyroid eye disease?

1. 1. • Severe obesity, a painful, bacterial skin infection affecting the eye socket (orbital cellulitis), inflammation of the muscles of the eye socket (orbital myositis), and orbital tumors are some of the disorders that can be mistakenly considered as thyroid eye disease.

5. Can Graves disease go away without treatment?

1. 1. • Sometimes, Graves disease fades away without any treatment. However, there is a possibility of causing serious complications, including death, if not treated.

Reference:

1. “Graves’ Disease.” National Institute of Diabetes and Digestive and Kidney Diseases, U.S. Department of Health and Human Services.
2.“Thyroid Eye Disease.” American Thyroid Association.

Image Courtesy:

1. “Graves disease – alt — high mag” By Librepath – Own work (CC BY-SA 3.0) via Commons Wikimedia

2. “Image from page 226 of “The thyroid gland in health and disease” (1917)” By Internet Archive Book Images  (Public Domain) via Flickr