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Psoriasis and Thyroid Eye Disease: What You Should Know

Medically reviewed by Paul B. Griggs, M.D.
Posted on June 20, 2024

Autoimmune diseases such as psoriasis and thyroid eye disease (TED) occur when a person’s immune system mistakenly attacks their body’s cells. Although these conditions affect different body parts — psoriasis affects the skin and TED affects the eye — many people are living with both conditions at the same time.

One MyPsoriasisTeam member asked, “Does anyone have more than one autoimmune disease?” In response, other members described their experiences with autoimmune thyroid disease such as Graves’ disease.

Here, we explain the connections and similarities between these autoimmune diseases. We will discuss what to do if you’re living with psoriasis and think you may have symptoms of thyroid disease.

What Is an Autoimmune Disease?

When a person’s immune system doesn’t work like it should, they can develop an autoimmune disease. In this type of disease, antibodies (proteins produced by immune cells) attack and destroy cells in a specific part of a person’s body. Currently, more than 50 million people in the United States are living with at least one of the 80-plus known autoimmune diseases. Some of the more common autoimmune conditions include psoriasis and Graves’ disease (the autoimmune disease behind most cases of TED).

Others include:

  • Lupus
  • Rheumatoid arthritis
  • Type 1 diabetes
  • Sjogren’s syndrome

Who Gets Autoimmune Disease?

Anyone can develop an autoimmune disease, although certain traits can make someone have a higher risk for certain autoimmune diseases.

Sex

Although autoimmune illness can affect people of every age, biological sex, and race/ethnicity, 80 percent of people with autoimmune disease are female. Being female is a risk factor for TED. Being male is a risk factor for more severe TED.

Family History

Compared to the general population, a person with a family history of a specific autoimmune disease is more likely to get that disease.

Race

Members of certain races and ethnicities are more prone to specific autoimmune disorders. According to the National Psoriasis Foundation, psoriasis is more likely to occur in white people — although this could be in part because it sometimes goes undetected or misdiagnosed among people with darker skin tones. In darker skin, psoriasis may appear more purple or dark brown with grey scales, making it less recognizable compared to the classic red and white scale appearance on lighter skin.

TED is more common among Black/African American people and white people than in Hispanic and Asian individuals.

What Is Psoriasis?

In psoriasis, the immune system specifically attacks healthy skin cells instead of just foreign invaders. This creates inflammation and excessive growth of skin, creating the scaly plaques that you see on your body.

Symptoms of psoriasis include scaly plaques and itchy, cracked, painful, and/or dry skin.

What Is Thyroid Eye Disease?

TED, the inflammation and damage of the tissues around the eyes, is usually the result of an autoimmune thyroid disease called Graves’ disease. Graves’ disease is a type of hyperthyroidism, where your immune system causes your thyroid gland to release too much thyroid hormone.

Common Graves’ disease symptoms include weight loss, rapid heartbeat, and anxiety. Many people with Graves’ disease eventually get TED, where the tissues around the eyes become inflamed and damaged.

Symptoms of TED include:

  • Proptosis (bulging eyes)
  • Diplopia (double vision)
  • Strabismus (crossed eyes)
  • Eye pain
  • Difficulty closing one’s eyes

The Risk for Graves’ and TED in People With Psoriasis

Multiple studies have shown that living with psoriasis increases a person’s chances of having or developing thyroid disease. The biological reason for this has been studied but is still debated.

Psoriasis and Hyperthyroidism

Psoriasis has been linked to an increased risk of both hypothyroidism (such as Hashimoto’s thyroiditis) and hyperthyroidism, including Graves’ disease. The odds of an individual with psoriasis having Graves’ disease are about 1.3 times higher than those without psoriasis. Although this research indicates a modest association, further studies are needed to fully understand the relationship.

Psoriasis and TED

No studies have looked specifically at the relationship between psoriasis and TED. While they are both autoimmune conditions with similar causes and risk factors, current evidence does not suggest that people with psoriasis are at a significantly increased risk for TED. However, it is still possible for individuals to experience both conditions at the same time.

Talk to Your Doctor

If you’re living with psoriasis and begin to experience symptoms such as weight loss, palpitations, vision changes, or changes to the appearance of your eyes, contact your primary care doctor or endocrinologist.

Testing for thyroid disease involves a simple blood test for your thyroid hormone and thyroid-stimulating hormone (TSH) levels. Detecting thyroid disease early can help prevent complications and ensure you get the care you need.

Graves’ Disease and TED Treatment

If you can recognize the symptoms of hyperthyroidism and TED, you and your doctor can treat it early on. Treatment of Graves’ varies on the severity of your thyroid disease, but it may include interventions such as medication, radioactive iodine therapy, and thyroid surgery.

Common treatments for Graves’ disease, in order of least to most invasive, include:

  • Medications to reduce the production of thyroid hormones
  • Radioactive iodine therapy to destroy the overactive thyroid cells
  • Thyroid surgery to treat a thyroid that’s unresponsive to medical treatment

Treating Graves’ may help to stop TED from worsening, but it can’t reverse the damage done to the eye and surrounding tissue. Treatment for TED is separate and may include:

  • Medications such as corticosteroids or teprotumumab-trbw (Tepezza)
  • Lubricating eye drops to relieve dryness
  • Surgical procedures

Treating Both Psoriasis and Thyroid Disease

Managing multiple chronic conditions can take a toll on your quality of life. If you’re living with both psoriasis and TED, It may take many different types of doctors to treat all of your conditions. Even though psoriasis and TED are both autoimmune diseases, a dermatologist usually treats psoriasis and an ophthalmologist usually treats TED. Notably, an endocrinologist usually treats Graves’ disease.

Ask your doctors for referrals to other specialists as needed, and allow for your medical records to be shared between members of your health care team.

Talk With Others Who Understand

On MyPsoriasisTeam, the social network for people with psoriasis and their loved ones, more than 128,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis.

Are you living with both psoriasis and TED or Graves’ disease? How do you manage both conditions? Share your experience in the comments below or start a conversation by posting on your Activities page.

    Posted on June 20, 2024
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    Paul B. Griggs, M.D. is certified by the American Board of Ophthalmology. Learn more about him here.
    Scarlett Bergam, M.P.H. is a medical student at George Washington University and a former Fulbright research scholar in Durban, South Africa. Learn more about her here.

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