What part of the body itches with thyroid problems?

Hashimoto Thyroiditis

Thyroiditis is when your thyroid gland becomes irritated or inflamed. Hashimoto thyroiditis is the most common type of this health problem. It may also be called chronic autoimmune thyroiditis. This thyroiditis is an autoimmune disease. It occurs when your body makes antibodies that attack the cells in your thyroid. The thyroid gland becomes overrun with white blood cells and becomes scarred. This makes the gland feel firm and rubbery. The thyroid then can’t make enough of the thyroid hormone.

Many people with this problem have an underactive thyroid gland. That’s also known as hypothyroidism. They have to take medicine to keep their thyroid hormone levels normal.

What causes Hashimoto thyroiditis?

Hashimoto thyroiditis is an autoimmune disorder. Normally, your immune system protects your body by attacking bacteria and viruses. But with this disease, your immune system attacks your thyroid gland by mistake. Your thyroid then can’t make enough thyroid hormone, so your body can’t work as well.

Who is at risk for Hashimoto thyroiditis?

Things that may make it more likely for to get Hashimoto thyroiditis are:

Being a woman. Women are more likely to have the disease. Hashimoto thyroiditis sometimes begins during pregnancy. The condition may get better in some women during pregnancy. But then it may return after delivery.
Being middle age. Most cases happen between ages 30 and 60. But it has been seen in younger people.
Having a family member with the disease (heredity). The disease tends to run in families. But no gene has been found that carries it.
Having other autoimmune diseases. These health problems raise a person’s risk. Some examples are rheumatoid arthritis, Graves disease, and type 1 diabetes. Having this type of thyroiditis puts you at higher risk for other autoimmune illnesses.

What are the symptoms of Hashimoto thyroiditis?

Each person’s symptoms may vary. Symptoms may include:

Goiter

This is an enlargement of your thyroid gland. It causes a bulge on your neck. It is not cancer. But it can cause problems such as pain or trouble with swallowing, breathing, or speaking.

Underactive thyroid

When your thyroid doesn’t make enough thyroid hormone, it can cause these symptoms:

Tiredness
Muscle weakness and joint pain
Constipation
Weight gain
Not being able to handle cold
Depression
Hair and skin changes

Overactive thyroid

When the thyroid is attacked by antibodies, it may at first make more thyroid hormone. This is called hashitoxicosis. It does not happen to everyone. But it can cause these symptoms:

Not being able to handle heat
Fast heart rate
Sweating
Weight loss
Tremors
Anxiety

These symptoms may look like other health problems. Always see your healthcare provider for a diagnosis.

How is Hashimoto thyroiditis diagnosed?

Your healthcare provider will ask about your health history and give you a physical exam. You will also have blood tests. These can measure your thyroid hormone levels and check for certain antibodies that form against proteins in the thyroid.

How is Hashimoto thyroiditis treated?

Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is.

You will not need treatment if your thyroid hormone levels are normal. But Hashimoto thyroiditis can cause an underactive thyroid gland. If so, it can be treated with medicine. The medicine replaces lost thyroid hormone. That should stop your symptoms. It can also ease a goiter if you have one. A goiter can cause problems such as pain or trouble swallowing, breathing, or speaking. If these symptoms don’t get better, you may need surgery to remove the goiter.

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When should I call my healthcare provider?

Tell your healthcare provider if your symptoms get worse or you have new symptoms.

Key points about Hashimoto thyroiditis

Hashimoto thyroiditis can cause your thyroid to not make enough thyroid hormone.
It is an autoimmune disease. It occurs when your body makes antibodies that attack the cells in your thyroid.
Symptoms may include an enlarged thyroid gland (goiter), tiredness, weight gain, and muscle weakness.
You don’t need treatment if your thyroid hormone levels are normal. If you have an underactive thyroid, medicine can help.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

Know the reason for your visit and what you want to happen.
Before your visit, write down questions you want answered.
Bring someone with you to help you ask questions and remember what your provider tells you.
At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
Know why a new medicine or treatment is prescribed and how it will help you. Also know what the side effects are.
Ask if your condition can be treated in other ways.
Know why a test or procedure is recommended and what the results could mean.
Know what to expect if you do not take the medicine or have the test or procedure.
If you have a follow-up appointment, write down the date, time, and purpose for that visit.
Know how you can contact your provider if you have questions.

Medical Reviewer: Robert Hurd MD
Medical Reviewer: Ronald Karlin MD
Medical Reviewer: Maryann Foley RN BSN

Thyroid eye disease

Thyroid eye disease is an autoimmune condition that affects the eyes causing swelling, inflammation and sometimes visual problems.

Alternative names for thyroid eye disease

TED; Graves’ ophthalmopathy; Graves’ orbitopathy; Graves’ eye disease; thyroid ophthalmopathy; thyroid associated ophthalmopathy; thyroid associated orbitopathy

What is thyroid eye disease?

Thyroid eye disease is an autoimmune condition affecting the eyes that is associated with Graves’ disease. Graves’ disease is an autoimmune thyroid condition where the body’s immune system produces auto-antibodies that activate receptors in the thyroid gland causing it to produce too much thyroid hormone (hyperthyroidism). This immune response against the thyroid gland can sometimes also affect the eyes – as in thyroid eye disease.

What causes thyroid eye disease?

The exact cause of thyroid eye disease is not known but it is thought to be caused by an abnormal immune response that is targeted at the healthy tissues of the eye. This leads to the eyes becoming sore, watery, swollen and red. This inflammation is directed against several different parts of the eyes, including the muscle and fat behind the eyes. This results in the eyes becoming prominent or giving an appearance of a permanent stare. Similar inflammation of the muscles that move the eye can result in the muscles becoming stiff. As a result, the eyes do not move together, causing double vision. In severe cases of stiffness, squinting may result.

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What are the signs and symptoms of thyroid eye disease?

Early symptoms of thyroid eye disease are itching, watering or dry eyes and a feeling of grittiness of the eyes. Some people may notice a swelling around the eyelids and sometimes the front of the eye becomes swollen. The eyelids may become uneven in size and they may seem to sit further back on the eyeballs (known as retraction of the eyelids). Patients may experience prominent or protruding eyes (like a stare), and in more advanced cases, double vision.
Rarely, patients may not be able to completely close their eyes due to protrusion of the eyeball. This exposes the cornea (membrane that covers the eyeball) to damage from dirt, causing reduced vision. Sometimes the swelling at the back of the eyes can press on the nerve behind the eye (optic nerve) causing pain, ‘washed out’ colour vision and reduced vision which, if untreated, can lead to blindness.

How common is thyroid eye disease?

About one in four patients with Graves’ disease will have thyroid eye disease. It does not occur with other causes of an overactive thyroid (such as a toxic thyroid nodule).

Thyroid eye disease is almost five times more common in women than men. However, the disease is often more severe in men. In 90% of people it is associated with an overactive gland, in which case it may be diagnosed before, after, or at the time of diagnosis of Graves’ disease. In 5% of people it is associated with an underactive thyroid gland and 5% of people affected do not have any thyroid problems. Thyroid eye disease is seven times more likely to occur in smokers.

Is thyroid eye disease inherited?

No, thyroid eye disease is not inherited. However, autoimmune conditions tend to run in families, and it is likely that a patient with thyroid eye disease may have some other autoimmune disease.

How is thyroid eye disease diagnosed?

Thyroid eye disease is often diagnosed at the same time as Graves’ disease. The signs and symptoms described above such as red, swollen eyes will prompt the doctor to suspect thyroid eye disease. A simple blood test called thyroid function test will be carried out to measure the levels of thyroid hormones (thyroxine and triiodothyronine) and thyroid stimulating hormone in the bloodstream. In Graves’ disease, levels of thyroxine and/or triiodothyronine will usually be raised with undetectable levels of thyroid stimulating hormone. Blood tests may also be carried out to detect thyroid antibodies, which would indicate autoimmune thyroid disease.

If the signs and symptoms are doubtful (for instance, if only one eye is affected), a computerised tomography (CT) or magnetic resonance imaging (MRI) scan of the eyes may be used to examine any swelling of the tissues behind the eye.

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How is thyroid eye disease treated?

It is important to keep the thyroid function stable. The treatment will depend on whether the thyroid gland is overactive (majority of cases) or underactive. An overactive gland is treated with anti-thyroid tablets, usually carbimazole or occasionally propylthiouracil, to treat the raised hormone levels. These act on enzymes in the thyroid gland to reduce production of thyroid hormones. In the case of an underactive gland, thyroxine replacement tablets will need to be taken daily for life (see the article on hypothyroidism for more information).

Smoking is the biggest external factor known to make the disease worse and it is important for affected people to stop smoking immediately.

Symptoms of thyroid eye disease should be treated as they happen. These can include:

• dry eyes – use of artificial liquid tears can help

• eyes not closing at night – ointment, eye pads and taping the eyelids closed can help to keep the eye moist and protected

• swelling around the eyes – raising the head further at night with the help of extra pillows or raising the head end of the bed may help

• double vision – use of special glasses with prisms can help; after the disease has settled down, eye muscle surgery can correct residual double vision

• deteriorating vision or worsening prominence – medications such as steroids or steroid-like medications (immunosuppressive treatment) are used to reduce the swelling. They are usually used at a high dose to start with and continued for a long time. Radiotherapy to the tissues behind the eyes is also effective but takes several months to work.

It may be important to continue these treatments until the inflammation dies down, which generally takes 12 to 18 months. The extent of the residual effects of the disease can then be assessed. Following significant thyroid eye disease, rehabilitative surgery is frequently required to return the eyes to their previous appearance and function. A series of different operations including operating on the eyelids, eye muscles or orbital decompression to reduce the pressure behind the eyes, may be needed. If there is any risk to vision, decompression by surgery may need to be carried out urgently.

Are there any side-effects to the treatment?

Long-term treatment with steroids used in severe cases of thyroid eye disease (if the vision is deteriorating) can cause side-effects such as weight gain, diabetes and osteoporosis (brittle bones).

Surgery for cosmetic reasons should be carried out after the inflammation has died down in order to avoid repeated operations. There are general risks associated with surgery and anaesthesia, which should be explained by the surgeon and/or anaesthetist.

Antithyroid tablets can very rarely suppress the production of white blood cells, making the individual more open to infections. Anyone who experiences a sore throat, mouth ulcers or a high temperature whilst taking the tablets should seek medical attention immediately.

Radioiodine therapy used to treat an overactive thyroid gland can worsen thyroid eye disease so this should be avoided while the eyes are inflamed. Radioiodine is therefore only used in mild eye disease if felt necessary and is usually combined with steroid treatment to minimise the risk.

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Patients should discuss any concerns with their doctor in case steroids need to be given before or after treatment.

What are the longer-term implications of thyroid eye disease?

With the correct treatment, thyroid eye disease can be well managed and patients can live full and active lives. Most of the effects of the thyroid eye disease will settle with time and when thyroid function is stabilised. Patients taking carbimazole tablets to treat hyperthyroidism may need to take them daily for life, although definitive treatment of the overactive thyroid gland with radioiodine or surgery is generally preferred, once the eye disease has settled down. Regular blood tests should be carried out to monitor thyroid hormone levels and the dose of carbimazole adjusted accordingly. However, there are other treatment options such as thyroidectomy or radioiodine treatment that can be considered once the eye disease has settled down.

The changes in the physical appearance of the eyes can have a psychological effect on the individual, causing low self-esteem. The long-term consequences of the disease, even after the thyroid has settled down, may be difficult to accept. Some patients may have a permanent change to their appearance, which may require surgery. Very rarely, there is a permanent loss of vision – this can happen if the disease is left untreated at the sight-threatening stage.

Patients should stop smoking as this is known to aggravate the condition. Sunglasses may be necessary even when indoors. If double vision is not corrected, driving will be dangerous. Patients should discuss any concerns with their doctor.

Are there patient support groups for people with thyroid eye disease?

Thyroid Eye Disease Charitable Trust may be able to provide advice and support to patients and their families.
British Thyroid Foundation

Last reviewed: Jul 2021

Overactive thyroid (hyperthyroidism)

An overactive thyroid is where the thyroid gland produces too much of the thyroid hormones. The thyroid is found at the front of the neck. An overactive thyroid can affect anyone. It is more common in women than men. The number of people affected by the condition increases with age.

Symptoms of an overactive thyroid

The thyroid produces hormones that affect things such as:

growth
development
metabolism (converts fuel in food to energy needed by the body)

The hormones can also affect your heart rate and body temperature.

An overactive thyroid (hyperthyroidism) can cause a wide range of possible symptoms. It’s unlikely you’ll experience all of them.

The symptoms may develop gradually or suddenly. For some people they’re quite mild. For others, they can be severe and significantly affect their life.

Common symptoms

Symptoms of an overactive thyroid can include:

nervousness, anxiety and irritability
hyperactivity – you may find it hard to stay still and feel full of nervous energy
mood swings
difficulty sleeping
exercise intolerance, fatigue, muscle weakness
sensitivity to heat
increased appetite with weight loss (or occasionally weight gain)
diarrhoea
needing to pee more often than usual
persistent thirst
itchiness
loss of interest in sex
difficulty in controlling blood glucose in people with diabetes
difficulty in swallowing if the thyroid gland is enlarged

Older people may present with few symptoms or other symptoms, such as deterioration of pre-existing heart disease, depression, or anorexia, which may make the diagnosis more difficult.

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Common signs

An overactive thyroid can also cause the following physical signs including:

a swelling in your neck caused by an enlarged thyroid gland (goitre)
an irregular and/or unusually fast heart rate (palpitations)
twitching or tremor
warm skin and sweating a lot
red palms of your hands
loose nails
a raised, itchy rash – known as hives (urticaria)
patchy hair loss or thinning
weight loss – often despite an increased appetite
eyes open more than normal giving a startled appearance
eye problems, such as redness, dryness or vision problems
ankle swelling
wasting of your muscles
gynaecomastia — development of breast tissue in men

When to see your GP

See your GP if you have symptoms of an overactive thyroid.

They will ask about your symptoms. They can also arrange a blood test if they think you might have a thyroid problem. This is to check the hormone levels to see how well your thyroid is working.

If the blood test shows that you have an overactive thyroid, you may be referred for further tests to identify the cause.

Treatments for an overactive thyroid

An overactive thyroid is usually treatable.

The main treatments are:

medication that stops your thyroid producing too much of the thyroid hormones
radioiodine treatment – where radiation is used to damage your thyroid, reducing its ability to produce thyroid hormones
surgery to remove some or all of your thyroid, so that it no longer produces thyroid hormones

Each of these treatments has benefits and drawbacks. You’ll normally see an endocrinologist (specialist in hormone conditions) to discuss which is best for you.

Causes of an overactive thyroid

There are a number of reasons why the thyroid can become overactive.

Graves’ disease – where the body’s immune system mistakenly attacks and damages the thyroid
lumps (nodules) on the thyroid – this results in extra thyroid tissue, which can mean extra thyroid hormones are produced
certain medications

Graves’ disease

About three in every four cases of overactive thyroid are because of Graves’ disease.

Graves’ disease is an autoimmune condition. This means the immune system mistakenly attacks a part of the body — in this case the thyroid gland. The damaged thyroid gland becomes overactive (producing too much of the thyroid hormones).

The cause of Graves’ disease is unknown. It mostly affects young or middle-aged women and it often runs in families. Smoking can also increase your risk of getting it.