Are Dark Circles a Sign of Thyroid Issues or Something Else?

Dark circles around the eyes are known as periorbital and intra-orbital dark circles. While generally not a cause of medical concern, they are aesthetically displeasing for many individuals and can occur across all age brackets. Visually, dark circles are characterized by differences in color between the palpebral (region around the eyelids) and surrounding areas of facial skin. While a variety of treatment options exist, dark circles represent a common and multifactorial challenge in the world of aesthetic medicine.

What Are Dark Circles?

Dark circles are discoloration or shadowing under the eyes. They are the result of a variety of factors including deep facial anatomy, soft tissue changes, and contributions from the skin. Depending on skin tone, genetics, aging, lifestyle, and health, dark circles can appear bluish, brownish, purplish, or a mix. Medically, they are known under several names like ‘infraorbital dark circles’, infraorbital pigment’, under-eye circles’ and ‘lower eyelid bags’. Etiology is multifactorial, with both physiological and environmental factors. The dark appearance comes from a combination of factors such as thinner skin under the eyes, visibility of blood vessels/capillaries, shadowing from puffiness or hollowness, hyperpigmentation, or a mix thereof.

The Link Between Thyroid Issues and Dark Circles

Thyroid disorders are a group of health conditions in which the thyroid gland is either underactive (hypothyroidism), overactive (hyperthyroidism), or autoimmune in nature (e.g., Graves’ disease, Hashimoto’s thyroiditis). These disorders manifest through many systemic effects on the skin, fluid balance and metabolism, all of which can indirectly lead to visible changes under the eyes.

Hypothyroidism can cause fatigue, weight gain, and fluid retention, causing puffiness around the eyes. That puffiness can cast shadows, making dark circles more visible. Hypothyroidism causes edema (swelling or fluid retention). In addition, the metabolic slowdown from hypothyroidism makes the skin thinner or lose its elasticity. This, in turn, makes blood vessels and capillaries beneath the skin more visible.

So, while thyroid issues can contribute to dark circles, they are not a definitive sign of thyroid disease in themselves.

Other Common Causes of Dark Circles

As mentioned above, dark circles have multifactorial reasons and apart from thyroid issues and other physiological factors, allergies, aging, lack of sleep, and hyperpigmentation are also associated in their development. Some of the established causes are:

Lack of Sleep or Poor Sleep Quality

Sleep deprivation reduces blood flow and causes skin to appear paler, making underlying vessels more noticeable. Also, lying flat on the back leads to fluid accumulation under the eyes, which increases puffiness and darkness.

Genetics and Skin Anatomy

Some people naturally have less subcutaneous fat and thinner skin under their eyes due to genetic preponderance. This makes underlying veins more visible or have deeper tear troughs (hollows) which cast shadows.

Age-Related Changes

The natural aging process involves collagen and elastin loss, skin thinning and slowing down of cell turnover and replacement. This makes the under-eye area more prone to showing veins, discoloration, or hollowing.

Allergies and Sinus Issues

Allergic reactions increase inflammation and induce sneezing fits. Plus, people may forcefully and excessively rub their eyes, which causes dilation of blood vessels or bruising. Also, congestion can lead to fluid retention and swelling.

Nutrition, Hydration, and Lifestyle

Iron deficiency (anemia) can cause paleness and make vessels more noticeable. Dehydration, high salt intake, alcohol use, and smoking can all affect fluid balance, skin, and eye health.

Pigmentation and Skin Conditions

Excessive sun exposure, hormonal changes, or genetic predisposition can lead to hyperpigmentation (extra melanin). Skin disorders like dermatitis or eczema can also lead to darkening (due to irritation, rubbing, itching and post-inflammatory pigment changes).

Underlying Medical Conditions

Beyond thyroid, kidney, liver disease, or sleep disorders (like sleep apnea) can contribute through fluid retention, poor circulation, or metabolic effects.

If Thyroid Issues are the Likely Cause of Dark Circles

Since thyroid disease is only one of many possible causes, it is important to look for patterns and other symptoms to ascertain thyroid involvement. These include:

• Other signs of thyroid disease include fatigue, sensitivity to cold, weight gain or loss, heart rate changes, mood changes, dry skin, thinning of hair, eyelashes or eyebrows.
• Persistent puffy or swollen under-eye bags.
• Dark circles that do not go away with improved sleep, allergy treatments, hydration, or skincare.
• Inflammation around the eyes, eyelid swelling, redness, discomfort, bulging or protruding eyes or changes in eyelid movement, such as inability or difficulty in closing the eyelids due to protruding eyes.
• History of thyroid condition (hypo- or hyper-thyroidism)

Treatment and Management

Effective treatment and management of dark circles depend on identifying the underlying cause, whether thyroid-related, lifestyle, or environmental.

The first step is to either rule out or confirm thyroid involvement in the manifestation of dark circles and for that a thyroid function test is necessary.

Get Medical Evaluation

• Test thyroid function: TSH, T4, T3, anti-thyroid antibodies if relevant.
• Check for anemia (iron levels, vitamin B12).
• Evaluate allergies, sleep quality and sleep function tests, kidney and liver function if pertinent, especially if anemia is suspected.

If thyroid-related issues are ruled out, then the next course of action is symptomatic relief to address the other extraneous factors related to lifestyle and the environment

Lifestyle Changes and At-Home Remedies

• Improve sleep hygiene and aim for consistent rest. If you are a back sleeper, elevate your head slightly to reduce fluid pooling.
• Stay hydrated with 6 – 8 glasses of water every day, and reduce salt intake.
• Avoid constant rubbing of eyes and protect yourself from allergens.
• Shield yourself from the sun with sunscreen and wear sunglasses.
• Maintain good nutrition with adequate protein, vitamins C, K and iron.

Practice Skincare

• Use eye creams that contain ingredients that promote skin thickness and reduce pigmentation (e.g., vitamin C, retinol, and peptides).
• Cold compresses can temporarily help to reduce swelling.
• Medical Interventions
• Laser or light therapies and chemical peels for dark pigment under eyes.
• Fillers or cosmetic surgery (like blepharoplasty) when there is a significant hollowing or puffiness component.

Management of Thyroid Disease

• Both hypothyroidism and hyperthyroidism should be appropriately addressed to help reduce related swelling, fluid retention, and metabolic slowdown.
• If thyroid eye disease (TED) is present, managing inflammation, eye care, possibly immunomodulation or other treatments should be initiated under ophthalmologic supervision.

When to See Your Doctor

Dark circles are often benign and cosmetic in nature. But it is prudent to consult a healthcare provider if:

• If dark circles appear suddenly or are asymmetric (e.g., one side looks much worse).
• If dark circles co-manifest with other symptoms like eye pain, vision changes, swelling and/or redness.
• Suspicion of undiagnosed known causative diseases (thyroid disorder, kidney, liver, etc.).
• Lifestyle improvements have no effect.

Take Control of Dark Circles with Help from Dr. Raymond Douglas

Dark circles are mostly caused by a mix of lifestyle, genetics, aging, allergies, and skin characteristics. But in select instances, underlying thyroid issues can also be a causative factor. (inflammation, swelling).

If you suspect your thyroid may be playing a role, or if your dark circles are severe or persistent, do not hesitate to schedule an appointment with Dr. Raymond Douglas.