Thyroid Eye Disease - Symptoms, Causes and Treatment

TED is an autoimmune condition where the immune system attacks the tissues around the eyes by mistake. This leads to inflammation that causes eye bulging, swelling, redness, and vision problems. TED is often associated with thyroid disorders, particularly hyperthyroidism and Graves’ disease. It has two phases:

1. The active phase, marked by inflammation, can last six months to two years.
2. The inactive phase is when disease progression stops. However, some individuals may experience double vision and bulging eyes.

Stages of Thyroid Eye Disease

The table above shows the classification of TED based on the European Grouon Graves’ Orbitopathy (EUGOGO). It categorises the severity of disease symptoms into mild, moderate to severe, and sight-threatening stages.

The symptoms of Graves’ eye disease occur due to inflammation of the eye. These physical thyroid eye disease signs may include the following:

1. Eyes popping out or bulging eyes disease (proptosis)
2. Redness (due to swelling of the conjunctiva)
3. Double vision (caused by misalignment of the eyes)
4. Pain in or around the eyes or during eye movement (swollen tissues restrict the movement of eye muscles)
5. Dry eyes and sensitivity to light
6. Excessive tearing or watering of the eyes
7. Puffiness or redness of the eyelids

Causes

The immune system protects an individual from germs that can make them sick. An autoimmune response primarily causes thyroid eye disease. In this condition, the immune system mistakenly attacks the tissues around the eyes, causing inflammation. However, the reason for this immune response is not clearly understood. 

Risk Factors

Some people are more likely to develop thyroid eye disease. Recognising the risk factors can help in early detection and better management of the condition. These include the following:

1. Graves’ Disease: It is the most significant risk factor, as TED is often associated with this autoimmune thyroid disorder.
2. Hyperthyroidism: An overactive thyroid or too much thyroid hormone increases the likelihood of developing TED.
3. Gender: According to a study by Subramaniam et al., 2022, women are affected by this condition 1.5-6 times more frequently than men. This is due to the higher incidence of autoimmune thyroid disorders in women.
4. Smoking: Smokers are two to eight times more likely to develop thyroid eye disease.
5. Genetic Factors: Patients with a family history of thyroid disorders or autoimmune conditions are at a higher risk.
6. Radioiodine Therapy: Treatment for hyperthyroidism with radioactive iodine can trigger or worsen TED. This is potentially due to the release of antigens by radiation-induced thyroid damage. These antigens are shared by thyroid and eye tissues, increasing the risk of the condition.

While it is not possible to prevent thyroid eye disease, there are certain steps to manage risk factors and maintain overall health. Here are some key preventive measures:

1. Quit Smoking: It can help decrease the risk of TED and improve treatment outcomes.
2. Manage Thyroid Levels: Keep thyroid hormone levels within the normal range through regular monitoring and appropriate medication.
3. Precautions for Radioiodine Treatment: Those undergoing this therapy for hyperthyroidism should consult their eye doctor regarding the risks and preventative measures to protect the eyes.
4. Selenium Supplements: For mild thyroid eye disease, taking 100 mcg of these supplements twice daily for six months can be beneficial. However, it is important to consult a doctor for personalised recommendations.

Diagnosing Graves’ eye disease involves a physical exam to evaluate both the eyelids and eyes. The doctor will order the following tests if they suspect this condition:

1. Blood Tests: They measure thyroid hormone levels and detect antibodies associated with Graves’ disease.
2. Imaging Studies: These include the following:
1. CT Scan or MRI: Provide detailed pictures of the eye muscles and tissues, helping to assess the extent of inflammation.
2. Ultrasound: Evaluates the thyroid gland and surrounding tissues.

How to prepare for a doctor consultation?

Preparing for an ophthalmologist consultation involves gathering relevant information and taking specific steps to ensure a productive visit. Patients should consider the following:

1. Write down all the symptoms, including when they started and their severity.
2. Compile a detailed medical history, including thyroid conditions, previous treatments, and any family history of thyroid or autoimmune diseases.
3. Prepare a list of all ongoing medications, supplements, and vitamins, including dosages.
4. Bring the results of any recent eye examinations or imaging tests.
5. Be prepared to discuss lifestyle habits, such as smoking, diet, and stress levels, as these can impact the condition.

Questions to Ask the Doctor

Preparing a list of concerns to ask the eye doctor can help patients better understand thyroid eye disease and manage it effectively. You can consider the following questions:

1. What is causing my thyroid eye disease?
2. What treatment options are available for TED?
3. What are the potential side effects of the treatments?
4. Are there any lifestyle changes I should make to improve my condition?
5. What should I do if symptoms of bulging eye disease worsen or new symptoms appear?

Thyroid eye disease treatment involves a combination of approaches to manage symptoms, reduce inflammation, and prevent further complications. It is often tailored to the disease severity and the specific needs of the patient. Options include:

Lifestyle and Home Remedies

When used with medical treatments, these can help manage symptoms and improve comfort. Mentioned below are these modifications:

1. Quit smoking
2. Use cool compresses on the eye to reduce swelling
3. Elevate the head of the bed when lying down
4. Wear sunglasses for protection from light sensitivity and irritation
5. Tape the eyelids shut while sleeping to avoid dryness and corneal ulcers
6. Wear prism glasses or use an eye patch on one eye to correct double vision

Medications

Several cases of mild and severe thyroid eye disease can improve with over-the-counter or prescribed drugs. These include:

1. Artificial Tear Drops: For mild TED, they lubricate the eyes and relieve dryness.
2. Selenium Supplements: This medication is used when the patient has low blood levels of selenium.
3. Anti-inflammatory Drugs: They help alleviate inflammation and discomfort in severe TED. Examples include prednisone and other systemic steroids.

Surgical Treatments

These may be necessary for more severe cases of TED to correct eye alignment and relieve pressure. Surgical interventions include:

1. Orbital Decompression Surgery: Removes bone or soft tissue from behind the eyes to create more space in the eye socket. This reduces pressure on the optic nerve.
2. Eyelid Surgery: Adjusts the position of the eyelids to protect the cornea.
3. Eye Muscle Surgery: Helps correct double vision by moving the eye muscle. Patients may need more than one surgery.

Note: The treatment approach is selected based on the patient’s condition and the treating doctor’s opinion.

"As an oculoplastic surgeon, I've dedicated my career to helping patients who have also dealt with thyroid eye disease (TED) to reclaim their quality of life. This autoimmune condition can cause debilitating eye bulging, double vision, and even blindness if left unchecked.

However, with my advanced training and collaborative care approach, I'm able to provide the most comprehensive treatment plan each patient needs to manage their symptoms and prevent further vision damage. Patients know they're in compassionate, capable hands when they come to see me."

- Dr Jaideep Dhama

Ophthalmologist

Addressing thyroid eye disease is essential for preserving eye health and preventing more severe issues. Delays in treatment can exacerbate symptoms and lead to significant complications, such as:

1. Untreated TED can worsen eye misalignment (strabismus), leading to persistent double vision.
2. Severe cases can result in corneal exposure and ulceration due to the inability to close the eyes properly.
3. Rarely, it can cause increased pressure on the optic nerve, leading to permanent vision loss.
4. Ongoing symptoms can affect the quality of life, as individuals may experience anxiety and irritability.

When to call an eye doctor?

Recognising when to seek medical attention for TED is crucial for preventing serious complications. Patients with thyroid eye signs should contact their eye doctor if the symptoms persist.

Maintaining a healthy diet can help manage thyroid eye disease symptoms and support overall eye health.The following are some dietary recommendations for individuals with TED:

Foods to Eat

Patients should include the following in their diet to manage thyroid eye disease:

1. Calcium: Adequate intake of this mineral supports bone health and overall bodily functions. Individuals should consume non-dairy sources of calcium like broccoli, kale, chia seeds, soybeans, and tofu.
2. Magnesium: It transports calcium and potassium across cells. Sources include pumpkin seeds, spinach, dark chocolate, avocados, etc.
3. Selenium: Foods rich in selenium can help support thyroid function. These include Brazil nuts, sunflower seeds, tuna, and shrimp.

Foods to Avoid

It is also important to eliminate certain foods from the diet of a patient with Graves' orbitopathy. These include:

1. Gluten: It can sometimes exacerbate autoimmune conditions. Gluten is found in wheat, barley, and rye.
2. Dietary Iodine: Excessive iodine can worsen thyroid dysfunction. Therefore, it is important to avoid foods high in iodine, such as iodised salt, certain seafood, and seaweed.
3. Meat and Animal Products: Limit consumption of red meat and processed animal products like chicken. These can increase inflammation due to high levels of saturated fat and cause overall health issues.

The prices mentioned above are approximate. These vary based on factors like the surgeon’s expertise, choice of hospital, and insurance coverage. Patients are advised to consult HexaHealth experts for accurate expenses.

If left untreated, thyroid eye disease can lead to significant discomfort and vision problems. Early detection and lifestyle adjustments can improve outcomes and quality of life. Specialised treatments, such as orbital decompression surgery, may be necessary to manage severe cases effectively.

HexaHealth offers comprehensive support for individuals with thyroid eye disease signs, providing expert consultations. We help you throughout your treatment, from diagnosis to recovery. Contact us TODAY! 

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