Have you ever noticed that some people's eyes are a little bigger, as if they are bulging out? Or are the eyes swollen and red? Maybe you feel something like this yourself. In fact, this can be something deeper than a cosmetic problem that appears on the outside. Did you know that this can be caused by a problem with the thyroid gland in your body? Today we are talking about this condition that makes many people uncomfortable, but can be managed properly. Thyroid Eye Disease (TED).
Simply put, what is Thyroid Eye Disease (TED)?
Thyroid Eye Disease (TED) is a condition in which the tissues around your eyes, such as muscles and fat cells, become inflamed and swollen. This is caused by a problem with your body's own immune system. Simply put, the immune system, which is like an "army" that protects our body from disease, mistakenly starts attacking its own healthy cells. This is called an autoimmune disease.
In TED, the immune system attacks your thyroid gland as well as the tissues around your eyes. This condition is most often seen in people with Graves' disease, a condition in which the thyroid gland is overactive. That's why doctors sometimes call it Graves' Eye Disease.
Although this disease is a lifelong autoimmune condition, the effects on the eyes (TED) usually subside after a period of time in the active phase. This active phase can last for up to two years. During this time, symptoms may wax and wane. Most people are not severely affected, but for some, if severe, permanent damage to vision and vision may occur.
What are the symptoms of this disease?
The symptoms of TED can vary from person to person, but there are some common symptoms. These usually affect both eyes, but sometimes only one eye may be affected.
| Symptom | A simple explanation |
|---|---|
| Protrusion of the eyes (Proptosis) | This is the main symptom that most people see. The tissues behind the eyes swell, causing the eyeball to bulge out. |
| Eye discomfort and itching | You may constantly feel things like sand in your eyes, a gritty feeling, or an itchy feeling. |
| Swelling and redness of the eyelids (Blepharitis) | The area around the eyes, especially the upper and lower eyelids, may be swollen and red. |
| Dry eyes or excessive tearing | The eyes may feel dry because they are not closing properly. In response, the body may produce more tears. |
| Sensitivity to light (Photophobia) | It feels like my eyes are turning blue even when the sun is out and the lights are on. It's hard to keep my eyes open. |
| Eye pain and headache | When you move your eyes, you may feel a pressure-like pain behind your eyes. |
| Double Vision/Diplopia | As the muscles in the eyes swell, the movements of the two eyes become uncoordinated, causing one thing to appear as two. |
What are the possible complications if this condition becomes severe?
Fortunately, most people do not develop serious complications. After the active phase of the disease is over, the appearance and vision of the eyes may return to normal to some extent. However, in some cases, scarring of the tissues around the eyes can occur, causing permanent changes.
Permanent changes in appearance
- Eyelid retraction: The eyelids are pulled upwards, making the eyes look large and frightened.
- Protruding eyes: Eyes that are pushed forward can be permanent.
- Baggy eyes: Swelling around the eyes can be permanent.
Permanent changes in vision
- Blurry vision
- Double vision
- In severe cases, complete loss of vision: This is very rare. This happens when the tissue behind the eye swells up and presses on the optic nerve. This is an emergency.
Why does this happen? What are the risk factors?
As we said before, the main reason for this is an autoimmune process. Imagine that you have a key in your house. When you put the right key in it, the door opens. Now imagine that a thief comes and puts a fake key that is identical to that key and opens the door. Some of the things that make up our body's immune system (antibodies) behave in a similar way to thyroid hormones and attach to receptors in the thyroid gland and the tissues behind the eyes. This is why what affects the thyroid gland also affects the eyes.
There are several risk factors that can contribute to this condition:
- Being a woman: Women are about five times more likely to develop this disease than men. However, if a man does develop it, it is more likely to be slightly more severe.
- Abnormal thyroid hormone levels: Both increased (hyperthyroidism) or decreased (hypothyroidism) thyroid hormone levels can affect this.
- Radioiodine therapy: This is the main treatment for Graves' disease. However, in some people, this treatment can worsen or cause new TED.
- Smoking: This is the most important risk factor and one that you can control. People who smoke and are exposed to secondhand smoke are at a higher risk of developing TED. Also, if a smoker develops the disease, symptoms are more likely to be severe and last longer.
If you have TED, the best thing you can do for yourself is to quit smoking immediately if you smoke.
How does the doctor diagnose this disease?
Your doctor can usually get an idea of this condition by examining your eyes (physical eye exam). They will carefully observe things like the position of your eyelids and eyeballs.
In addition, the following tests may be ordered to confirm the diagnosis and check thyroid function:
- Blood tests: Checking thyroid hormone levels (TSH, T3, T4) and levels of antibodies against the thyroid gland.
- Ultrasound, CT, or MRI scans of the eyes: These scans can clearly see how swollen the muscles and other tissues behind the eyes are.
What are the treatments for this?
The type of treatment you need will depend on the stage and severity of your disease. While the disease is active, supportive treatments are used to control symptoms. Once the disease has subsided, surgery may be needed to restore vision and appearance.
Supportive care during active disease
| Treatment method | What happens to it? |
|---|---|
| Eye Drops | Provides relief from dry, red, and painful eyes. |
| Selenium supplements | Since selenium deficiency can worsen symptoms, taking these supplements under medical advice may provide relief. |
| Prism eyeglasses | These special glasses can be worn as a temporary solution to double vision. |
| Drugs that control thyroid hormones | If you have high thyroid hormone levels due to Graves' disease, you will be given medications such as Methimazole and Propylthiouracil to control it. |
| Corticosteroids | If symptoms are severe, your doctor may prescribe this medication (e.g., Prednisolone) for a short period of time to quickly reduce swelling and inflammation. |
| Radiation therapy | A low dose of radiation is directed behind the eyes, destroying active immune cells there and reducing swelling. |
Surgery if necessary
Surgery is often performed after the active phase of the disease has ended and the condition has stabilized. Only then can it be determined what permanent changes in appearance and vision have occurred.
- Orbital decompression surgery: If the pressure behind the eye is too high and there is a risk of damage to the optic nerve, a small section of the bone around the eye is removed to create space. This surgery is also done to reduce the protrusion of the eye.
- Eyelid surgery: This surgery is performed to restore the drooping eyelid.
- Eye muscle surgery: If double vision is permanent, surgery is performed on the eye muscles to restore eye movement to a single focus.
- Thyroidectomy: If medication is unable to control thyroid hormone levels, the thyroid gland may need to be surgically removed.
When to see your doctor immediately
As a person with TED, it's important to stay aware of your symptoms. Especially if you notice any changes in your vision, you should notify your medical team immediately.
If you experience any of the following symptoms, see a doctor immediately or go to a hospital's Emergency Department (ETU) without delay.
- If you feel like your field of vision is reduced and you can't see on either side.
- If the color has changed (e.g., red looks like a faded pink).
- If you suddenly experience severe eye pain.
This condition can have a big impact on your life. You may also feel emotionally distressed due to eye pain, discomfort, and changes in your appearance. Therefore, it is important to talk openly with your medical team and seek support from family and friends. If you feel like you are not getting the support you need, talk to your doctor about it. They will be able to provide you with the resources you need to support your mental well-being.
Take-Home Message
- Thyroid Eye Disease (TED) is an autoimmune condition associated with thyroid problems, particularly Graves' disease.
- Common symptoms include bulging eyes, swelling around the eyes, pain, and double vision.
- Smoking makes this disease much worse. The best thing you can do is to quit smoking completely.
- There are various treatments for this, including medications, radiation therapy, and surgery. Your doctor will decide which treatment is best for you.
- If you experience any sudden changes in your vision (decreased visual range, color vision changes) , seek medical advice immediately.
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