Thyroid eye disease (TED) is usually associated with conditions like Graves’ disease — but it can also affect people without thyroid disorders. Doctors and researchers have found that people with other autoimmune diseases are also at risk of developing TED. An autoimmune disease happens when the body’s immune system, which normally helps protect it from infection and disease, mistakenly attacks and damages its own healthy tissues.

Keep reading to learn more about nine conditions related to TED. If you have any of these diseases and you’re experiencing TED symptoms, talk to your health care provider. They can refer you to an eye specialist (ophthalmologist) to make a diagnosis.

1. Graves’ Disease

Graves’ disease is an autoimmune disease that occurs when the body makes too many thyroid hormones (hyperthyroidism). In Graves’ disease, specialized immune system proteins known as antibodies attack the thyroid gland. This process leads to the overproduction of thyroid hormones, causing symptoms like:

• Enlarged thyroid gland (goiter) in the front of the neck
• Fatigue
• Sensitivity to heat
• Unexplained weight loss
• Trouble sleeping

The thyroid antibodies in Graves’ disease can also mistakenly attack the eyes, leading to TED. Up to 50 percent of people with Graves’ disease will develop TED at some point in their lives. This is why you may hear TED called Graves’ orbitopathy or Graves’ ophthalmopathy. However, people with normal thyroid hormone levels (euthyroid) or low levels (hypothyroidism) can also develop TED.

2. Rheumatoid Arthritis

Studies have shown that other autoimmune diseases are associated with TED. Rheumatoid arthritis (RA) is an inflammatory condition caused by the immune system attacking the lining of the joints. People with RA usually have warm, painful, stiff, or swollen joints.

In a study of 267 people with TED, 10 people (3.7 percent) had RA. By comparison, 0.4 percent to 1.2 percent of the general population lives with RA. This means that people with TED may be more likely to develop RA than others. Researchers think that genetics may play a role. For example, changes in certain immune system genes are seen in those with RA and TED.

3. Type 1 Diabetes

Type 1 diabetes is an autoimmune disease that causes high blood sugar levels. People with type 1 diabetes have antibodies that attack the pancreas — the organ that makes the hormone known as insulin. The body’s cells need insulin to use sugar for energy. Without enough insulin, your cells can’t use the sugar, so it stays in your bloodstream.

Studies show that people with TED tend to have type 1 diabetes more often than the general population. One report found that 5.1 percent of people with TED have type 1 diabetes. On the other hand, type 1 diabetes is only found in 0.5 percent of the general population. This means that type 1 diabetes is 10 times more common in people with TED. People with type 1 diabetes are also more likely to develop severe TED that can lead to vision loss.

Researchers have found there is some overlap between type 1 diabetes and Graves’ disease. They both involve antibodies that attack the body’s organs. Some studies from the journal Endocrine Practice show that people with Graves’ disease have antibodies that attack the pancreas. People with type 1 diabetes can also have thyroid antibodies that may lead to Graves’ disease and TED.

4. Systemic Lupus Erythematosus

Systemic lupus erythematosus (SLE) — or lupus for short — is an autoimmune disease that attacks several of the body’s organs. In SLE, antibodies attack the skin, joints, kidneys, blood cells, and brain. This attack leads to a variety of symptoms that can range from mild to severe, including:

• Fever
• Fatigue
• Malar rash — Skin rash along the cheeks and nose, also called a butterfly rash
• Pain, swollen joints
• Abdominal pain
• Dizziness and headaches

The study cited in the journal Frontiers in Endocrinology, which followed 267 people with TED, found that two individuals had SLE (0.7 percent). Common eye symptoms seen in people with lupus and TED include dry eyes, blurry vision, bulging eyes (proptosis), and pain.

5. Vitiligo

Vitiligo is a skin condition that develops when the immune system attacks and destroys melanocytes, which are specialized skin cells that make melanin — the pigment that gives your skin its color. People with vitiligo have patches of skin that are lighter than their natural skin tone. The patches can form anywhere on the body, but they’re most common on the face, arms, hands, and feet.

You’re more likely to develop vitiligo if you have another autoimmune condition, including thyroid disease. The study of 267 people with TED found that eight people (3 percent) were also living with vitiligo. The majority (seven people) were Black, Asian, or ethnic minorities, as defined by the study authors.

6. Addison’s Disease/Adrenal Insufficiency

Addison’s disease — also known as adrenal insufficiency — is an autoimmune disease that attacks the adrenal glands. These triangle-shaped glands sit on top of your kidneys and make the hormones aldosterone and cortisol.

People with Addison’s disease don’t make enough of these hormones, which can lead to fatigue, abdominal pain, low blood pressure, and low blood sugar levels. Addison’s disease is more common in those with other autoimmune diseases, including Graves’ disease, type 1 diabetes, and vitiligo.

Researchers have found that Addison’s disease can also cause eye problems like TED. Some reports from the Indian Journal of Endocrinology and Metabolism show that people can experience ptosis, sores or ulcers on the eyes, and swelling.

7. Celiac Disease

People with celiac disease can’t eat gluten — a protein found in foods made with barley, wheat, or rye. This is because gluten sets off an immune reaction in the small intestine. The immune system creates inflammation and sends antibodies to the intestine to destroy the gluten. Over time, this process destroys the intestinal tissue so it can’t absorb nutrients from food as well as it used to.

Research shows that people with celiac disease are four times as likely to have autoimmune thyroid diseases, including Graves’ disease and Hashimoto’s thyroiditis. Researchers believe this may be because celiac disease and thyroid diseases share similar genetics. If you have celiac disease, you may be at risk of developing TED.

8. Psoriasis

Psoriasis is an autoimmune disease that affects the skin and is caused by an overactive immune system. Extra skin inflammation causes skin cells to grow quicker than normal. They begin piling up on the surface, creating raised psoriasis plaques or lesions. People with psoriasis often say these plaques itch and burn. Although they can develop anywhere on the body, plaques normally form on the scalp, knees, and elbows.

The same study of 267 people with TED also found that eight people (3 percent) had psoriasis. This is about twice as high as psoriasis rates seen in the general population (1.3 percent). Like RA, the connection between psoriasis and TED may be due to shared genes in the two diseases.

9. Mental Health Disorders

Outside of autoimmune conditions, people with TED are also likely to have mental health disorders. This is because TED symptoms — like pain, swelling, and bulging eyes — can all affect your quality of life.

One study of 100 people with TED found that 34 percent of participants had anxiety and 28 percent had depression. Those with lower quality of life experienced more pain, double vision, and blurry vision. The authors also found that visiting the doctor more often and having surgery to treat TED also played a role in mental health.

TED is not only linked to thyroid disorders like Graves’ disease. It can also develop in people without any thyroid problems. This condition is also seen in individuals with other autoimmune diseases. Understanding this link is key to improving how we diagnose and treat TED. It helps health care providers offer more personalized care that better matches each person’s needs.

Talk With Others Who Understand

On TEDhealthteam, the social network for people living with thyroid eye disease and their loved ones, members come together to ask questions, give advice, and share their stories with those who understand life with TED.

Are you living with a condition related to TED? Have you experienced any symptoms of TED? Share your experience in the comments below, or start a conversation by posting on your Activities page.