Have you ever heard that thyroid problems can affect your eyes? Sometimes, one disease can be linked to another in ways we don't even realize. That's what thyroid eye disease, or as it's called among doctors, is called (Thyroid Eye Disease - TED). This is when the delicate tissues around your eyes swell. This can cause discomfort and pain in your eyes. This condition is often seen in people with autoimmune diseases that attack the thyroid gland. This is especially common in people with a disease called (Graves' disease). That's why doctors sometimes call it Graves' Eye Disease.
What exactly is thyroid eye disease (TED)?
Simply put, Thyroid Eye Disease (TED) is a condition that affects the tissues around your eyes, causing them to swell. It is an autoimmune disease, meaning that your body's own immune system mistakenly attacks the thyroid gland as well as the tissues around your eyes.
Think of it like our immune system is like an army that protects our country. But sometimes this army makes a mistake and attacks its own people. That's what happens in autoimmune diseases.
TED is not a condition that comes and goes. It has different stages. The swelling and discomfort can come and go for two years or more. Symptoms vary from person to person; some people may experience very little, while others may experience severe symptoms. For most people, it is not serious. However, if it becomes severe, it can cause permanent damage to the eyes, changes in appearance, and vision loss.
You may have heard doctors use other names for this condition. These names include:
- Thyroid ophthalmopathy
- Thyroid orbitopathy
- Graves' ophthalmopathy
- Graves' orbitopathy
These are all just different names for the same condition, so don't worry.
What are the symptoms of thyroid eye disease (TED)?
Now let's see how you can recognize this condition. See if you have one or more of these symptoms:
- Proptosis: The eyes appear to be enlarged and protruding.
- Itchy, burning eyes: It just feels uncomfortable, like something is wrong with your eyes.
- Swelling and redness of the eyelids (Blepharitis): The edges of the eyelids may be swollen and red.
- Dry eyes or frequent tearing: Some people experience dry eyes, while others simply experience tears.
- Frequent blinking: Frequent, uncontrollable blinking of the eyes.
- Sensitivity to light (Photophobia): Eyes become blue, making it difficult to see even when the sun is out or the lights are on.
- Eye pain and headache: Pain around the eyes, possibly accompanied by a headache.
- Difficulty moving the eyes: It feels like it is difficult to move the eyes when looking up, down, or to the sides.
- Diplopia: Seeing one thing as two.
These symptoms usually affect both eyes, but sometimes these symptoms can be seen in just one eye.
What are the complications of Graves' Eye Disease?
After the active phase of thyroid eye disease is over, the changes in the appearance and vision of the eyes may improve. But this does not always happen. Sometimes, the tissues around the eyes may become scarred and may not return to normal. Also, some parts of the eye that affect vision may be permanently damaged. But don't worry, these things can be treated with surgery.
Possible permanent changes in appearance:
- Eyelid retraction
- Protruding eyes
- Baggy eyes
- Red eyes
Permanent changes in vision may occur:
- Blurry vision
- Double vision
- Severe vision loss - This is very rare, but good to know.
Why do we get thyroid eye disease (TED)?
As we mentioned earlier, it's an autoimmune disease. This means your body's own immune system attacks your thyroid gland and the tissues around your eyes. Graves' disease is the most common cause. But it can also occur in people with other autoimmune thyroid diseases, such as Hashimoto's disease. Surprisingly, sometimes people who have no thyroid problems and normal thyroid hormone levels can develop TED.
In these diseases, certain antibodies produced by your immune system act like thyroid hormones and attach to thyroid hormone receptors. These receptors are mostly found in the thyroid gland, but some are also found in the tissues behind the eyes. So, the same antibodies that affect the thyroid also affect the eyes.
Who is most at risk of developing (TED)?
Some people are more likely to develop this condition. See if you fall into one of these categories:
- If you're a woman: Women are about five times more likely to develop Graves' disease and Graves' eye disease than men. (However, if a man does develop it, it's more likely to be severe.)
- If your thyroid hormone levels are abnormal: Both high (hyperthyroidism) and low (hypothyroidism) thyroid hormone levels can contribute to TED. These hormones, like the antibodies we talked about earlier, stimulate receptors in the tissues of the eyes.
- If you have had radioiodine therapy (RAI therapy): RAI therapy is a mainstay treatment for hyperthyroidism. However, it can contribute to or worsen TED.
- If you smoke: This is very important. People who smoke and are exposed to secondhand smoke are at significantly higher risk of developing thyroid eye disease. Also, symptoms are more likely to be severe and last longer in smokers. If you have TED, the best thing you can do for yourself is to quit smoking.
How do I find out if there are doctors (TED)?
Your doctor can diagnose this condition by performing a physical eye exam and carefully observing your eyelids and eyes.
If such suspicion arises, they will order several blood tests to check your thyroid hormone levels and whether there are too many or too few of those antibodies in your blood.
In addition, the doctor may request several other tests:
- Ultrasound examination of the eyes
- CT Scan (Computed Tomography - CT) test
- MRI (Magnetic Resonance Imaging - MRI) test
These tests can determine exactly how swollen the tissues around the eyes are and whether there is any pressure on the nerves.
What are the treatments for (TED)?
The type of treatment you need will depend on the stage of the disease and its severity. (TED) During the active phase, there are treatments that can help relieve symptoms. These may include home remedies, over-the-counter medications, or prescription medications. After the active phase is over, you may need surgery to restore your appearance or correct your vision.
Treatment to relieve symptoms
These treatments may help when TED is active:
- Eye drops: There are different types of eye drops to relieve dry, red, or painful eyes.
- Selenium supplements: Selenium deficiency has been found to increase symptoms of TED, so your doctor may recommend these.
- Scleral lenses: These are similar to contact lenses, but they cover a larger area of the eye, providing additional protection. They can also be used to administer medication.
- Vision aids: If you have double vision, your doctor may recommend using an eye patch or wearing glasses with special prisms.
- (Thionamides) Medications: If you have (hyperthyroidism) (due to Graves' disease), medications such as (methimazole) and (propylthiouracil) may be given to reduce thyroid hormone levels.
- Corticosteroids: If your symptoms are severe, your doctor may prescribe corticosteroids for a short period of time to reduce swelling. These can be given as pills taken by mouth or as an injection into a vein (IV).
- (Teprotumumab - Tepezza®): This is the first specific drug approved in the United States in 2020 to treat (TED). This is a new drug in a class called (biologics) that reduces inflammation. More drugs like this are being developed now.
- Radiation therapy: Consider radiation therapy to destroy active immune cells behind the eyes and reduce swelling. Your eye doctor may refer you to a radiation oncologist.
Remember, if these treatments don't work for you, your medical team will offer other treatment options. Surgery is rarely necessary during the active stage of Graves' eye disease. Most of the time, surgery is considered after your condition has stabilized. Only then can we know for sure what changes in appearance and vision will be permanent.
Surgery for (TED)
In some cases, surgery may be necessary:
- Orbital decompression surgery: Very rarely, this surgery is needed if swelling is causing pressure on the optic nerve. The surgeon removes a piece of bone to relieve the pressure. This is also done to reduce the bulging of the eye after the disease has subsided.
- Thyroidectomy: A treatment for severe hyperthyroidism. If medication fails to control thyroid hormone levels, the thyroid gland may need to be removed.
- Eyelid surgery: If your eyelids have fallen in, this surgery is done to restore them to their original shape. This not only relieves eye discomfort, but also improves appearance and protects the eye from exposure.
- Eye muscle surgery: This surgery may be necessary if the muscles that move the eyes are scarred and have difficulty moving the eyes, or if the eyes are misaligned and you see in two different directions.
- Oculoplastic surgery: This involves the reconstruction of the soft tissues and/or bones around the eyes. It can address cosmetic problems such as protruding eyes and bags under the eyes.
- Corneal transplant: If the cornea has been severely damaged due to exposure to the eye during the active phase of the disease, a corneal transplant may be considered to improve vision.
(TED) What is the outlook for the situation?
For most people, TED is not very severe, so the outlook is usually good. Most people have mild symptoms, which often go away on their own. However, symptoms can be more severe in people over the age of 50. If you have severe TED, you may need a combination of treatments to manage it. Some people can develop permanent changes to their eyes, which may require surgery.
When should I see a doctor?
If you have thyroid eye disease, it's important to let your healthcare team know if your symptoms get worse. You should also tell them if you notice any changes in your vision. Some changes may require emergency treatment. Call your doctor right away if you notice any of the following:
- If your field of vision seems to be narrowing, or if you are losing vision in one direction.
- If the colors look different than they should.
- If you suddenly experience severe eye pain.
Graves' eye disease can really affect your quality of life. Many people don't have severe symptoms, but it can be very distressing when they do. The swelling around your eyes can affect your comfort, vision, and appearance. It takes a team of doctors to help you cope with all of this. It's also important to have support in your personal life. If you're not getting the support you need, ask your medical team. They may be able to tell you about resources that can help you with your mental health.
Important things to remember (Take-Home Message)
Okay, so let's summarize some of the things you need to remember from what we've talked about:
- Thyroid eye disease (TED) is a condition that affects the eyes associated with problems with the thyroid gland.
- Be aware of symptoms such as bulging eyes, redness, swelling, and double vision.
- If you smoke, definitely quit. This is the biggest help you can do.
- If symptoms are severe or if you notice a change in vision , seek medical advice immediately.
- For most people, this condition is not serious, and there are various treatments available. So don't panic, but it is essential to seek proper medical attention.
- Your mental health is also very important during this time. Don't hesitate to seek help for that as well if you need it.
I hope this information is useful to you. Stay healthy!
` Thyroid eye disease, Graves' disease, eye swelling, eye redness, vision problems, thyroid, hormones
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