About Thyroid Eye Disease
Thyroid eye disease (TED), also known as Graves' eye disease, is an autoimmune disorder that attacks the thyroid gland. As a result, the thyroid gland typically becomes overactive and releases excess hormones. In some cases, the thyroid gland can become underactive; this is known as hypothyroidism. TED is usually caused by complications from Graves' disease. Common signs and symptoms of TED include bulging of the eyes, excessive dryness, sensitivity to bright light, blurred vision, swelling of the eyelids, bags under the eyes, pain or pressure, and difficulty moving the eyes. Ticho Eye Associates has helped countless patients who suffer from thyroid eye disorder. To book an appointment, contact our office in Chicago Ridge, IL, Tinley Park, IL, or Munster, IN.
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What is the Thyroid?
The thyroid gland is located at the base of the front of the neck below the larynx (voice box). It absorbs iodine from the blood and produces two hormones – thyroxine and triiodothyronine. It plays an important role in regulating the body’s metabolism.
What is Euthyroidism?
A condition of normal thyroid function is called euthyroidism.
What is Hyperthyroidism? What is Hypothyroidism?
If the thyroid gland malfunctions, it may produce either too much hormone (hyperthyroidism) or too little (hypothyroidism). An imbalance in either direction can cause a variety of symptoms. If the irregular production of hormones is because of an abnormal antibody, such as in Graves’ disease, then eye symptoms can develop as well.
What are the Symptoms of Hyperthyroidism?
Symptoms of hyperthyroidism include fatigue, fast heartbeat, weight loss, heat intolerance, thinning hair, and diarrhea. Hypothyroidism may also cause fatigue, but with a slow heartbeat, constipation, and weight gain.
Who usually gets Thyroid Eye Disease?
Although thyroid eye disorders can occur at any age, the average age at onset is 45 years. There are three times as many females with thyroid eye disorders than there are males.
What is the cause of Thyroid Eye Disease?
The most recent research suggests that autoimmunity is the underlying disease process in thyroid-associated eye disorders. Normally, the body’s immune mechanisms can distinguish clearly between what is a normal substance and what is foreign. In autoimmune disorders, this system becomes defective and the body then produces antibodies against normal tissue to such an extent as to cause tissue injury. In Graves’ disease, an abnormal antibody attacks the thyroid gland and causes it either to over-produce or possibly to under-produce thyroid hormones. This same antibody can attack the tissues surrounding the eye and cause various eye symptoms.
Does the Thyroid Abnormality Itself Cause Eye Disease?
No, the thyroid problems and the eye problems are different effects of the underlying autoimmune abnormality. It is important to realize that thyroid eye disease can occur even when tests show a normal level of thyroid hormone in the blood (euthyroid). However, most patients with eye symptoms have abnormal blood levels of thyroid hormone.
What are the Symptoms of Thyroid Eye Problems?
Nearly all of the symptoms from thyroid eye disease arise because of excessively swollen tissue around the eye. Pain or discomfort while trying to look up is often an early symptom. This is secondary to swelling of the eye muscles and other orbital tissue. A staring, wide-eyed appearance is often noticed because of retracted eyelids. Excessive eye watering is a frequent early condition as well, although dry eyes can develop with the progression of the disease. Some patients notice light sensitivity (photophobia).
Other signs of thyroid eye disorders include swelling (edema) of the eyelids and the tissues around the eye. Swelling of the normal fatty tissues surrounding the eye can push the whole eye forward from beneath the protective eyelid coverage, creating a prominence or protrusion of the eye (proptosis). The amount of proptosis is variable and may involve one or both eyes. Proptosis can result in stretching and compression of the optic nerve. This may damage the optic nerve, causing blurred vision, impaired color vision, and, possibly, a permanent loss of vision. In severe cases, the exposed clear covering of the eye (cornea) may develop severe dryness or even ulcers. The orbital swelling may also involve the muscles surrounding the eyeball. The muscles can become stiff and unable to relax. This may result in difficulty in moving the eyes and double vision (diplopia).
How is Thyroid Eye Disease Treated?
Once an abnormal thyroid gland is suspected, the thyroid function must be evaluated and appropriately treated if necessary. The priority is to restore the patient to a euthyroid condition. Sometimes the eye problems continue to progress even after the thyroid function is treated and returned to normal. Any remaining eye problems should be followed and, if necessary, treated by an ophthalmologist.
There are usually two phases of eye treatment for thyroid eye disorders. The first phase involves treating active eye disease and focuses on preserving sight. The most sight-threatening problem of a compressed optic nerve may require orbital decompression surgery. In this surgery, parts of the orbital bones are removed to create more “space” in the orbit. This helps to relieve pressure off of the optic nerve and will reduce the amount of proptosis. Radiation of the orbit can also reduce the amount of inflammation in the orbital tissue and help relieve optic nerve compression and proptosis. Sometimes high doses of anti-inflammatory steroids are used for the initial, acute phase of orbital swelling. Corneal exposure problems often require frequent application of artificial tears or plugging of the tear ducts. Patients may need to tape their eyelids shut at night. Tinted glasses may be helpful for light sensitivity, and edema may be reduced by raising the head of the bed. The active period, which may last two or more years, requires careful monitoring until the patient is stable.
The second phase of treatment involves correcting unacceptable permanent changes, which persist following the stabilization of the active phase. These changes persist mainly because of scar tissue, which develops from the excessive inflammation, and they include proptosis, strabismus (causing double vision), and eyelid retraction. Orbital decompression surgery is sometimes performed to improve disfiguring proptosis even if the vision is not compromised. It is preferable to perform decompression surgery first before any others that may be needed. Decompression surgery can worsen pre-existing strabismus or can create new strabismus. Double vision can be eliminated either with prism glasses if the strabismus is minimal or surgery if the strabismus is more severe. Eye muscle surgery to relax (or recess) tightened extraocular muscles is the preferred method of strabismus surgery in Graves’. Adjustable sutures are commonly used for these types of strabismus surgery. Eyelid retraction can be improved with various types of eyelid surgery in which the eyelid muscles are relaxed and/or spacer materials are inserted to return the eyelids to more natural positions. Eyelid surgery is best performed after decompression and eye muscle surgeries if needed.
manage Graves' eye disease
Identifying thyroid eye disease (TED) as early as possible is vital to maintaining optimal eye health. Our team of ophthalmologists at Ticho Eye Associates can perform a comprehensive eye assessment to determine the best treatment options for managing your symptoms. Reach out to our office in Chicago Ridge, IL, Tinley Park, IL, or Munster, IN today. Our team is here to serve you.