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The thyroid hormones are important for all cellular metabolism and when there is a deficiency of these hormones, it can cause a whole range of problems in the body. Many people suffering from hypothyroidism complain of puff eyes. This primarily occurs when the metabolism is affected resulting in the collection of glucoaminoglycans in the tissue surrounding the eyes. It can also affect other parts of the body, like the legs and the feet. When glucoaminiglycans accumulates in the tissues, it causes the face and the eyes to swell up. (See Reference 1)
One of the most obvious symptoms of hypothyroidism is puffiness of the eyes. It is present in majority of people suffering from this problem. Also, in people suffering autoimmune hypothyroidism, the eyes can appear to be bulging due to the puffiness. This is primarily because due to the fluid collection in the cells, the muscles of the eyes become stiff and congested. This can also affect the vision of the person leading to double vision. (See Reference 2) At times, the fluid collection can extend up to the cornea and this can result in the cornea drying up and getting inflamed which, in turn, can cause infections in the cornea or even ulcers. In some people, puffy eyes due to hypothyroidism can increase the internal pressure within the eyes resulting in glaucoma. (See Reference 2) Also, the increase pressure can adversely affect the optic nerves and this could result in loss of vision, which at times can be permanent.
Usually, when a person goes to a doctor for getting a diagnosis, the doctor will look for characteristic signs of hypothyroidism, and one of these signs is puff eyes. The symptoms and the blood test results will conclusively tell the doctor that the person is suffering from hypothyroidism. (See Reference 1) The doctor may also order MRI or CT scan to check whether the muscles or tissue of the eyes have been damaged due to the thyroid disorder.
After hypothyroidism has been diagnosed, the person will be put on thyroid medication. However, the puffy eyes will take some time to disappear. It will not happen overnight and the person should be patient. (See Reference 1)
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2. University of Illinois at Chicago: Thyroid Eye Disease