Thyroid Eye Disease: Causes, Symptoms, Treatments, Prevention

Thyroid eye disease or the Graves’ disease is an autoimmune thyroid condition that usually affects the thyroid, skin, and eyes.

When the gland produces excessive thyroid hormone, the condition is called hyperthyroidism. It usually affects the eyes, causing swelling, inflammation, and visual problems, also known as thyroid eye disease or Graves’ disease.

Since it is considered a rare disease, the exact prevalence of thyroid eye disease is not known. However, it is estimated to be 16 per 100,000 women in the general population and 2.9 per 100,000 men in the general population.

What is Thyroid Eye Disease (TED)?

Thyroid eye disease (TED) or Graves’ disease is an autoimmune disorder. As a result, the eye muscles, tear glands, and fatty tissues behind the eye get inflamed.

This may cause the eyes and eyelids to become red, swollen, or even bulging out.

There are also cases where the swelling and stiffness of the eye muscles causes them to no longer move in line with each other leading to double vision.

What are the causes of thyroid eye disease?

The exact scientific reason or cause for TED is unknown, but it may be caused by an abnormal immune response that targets the healthy tissue of the eye.

The immune system sends out antibodies that attack the fat, muscle, and other tissues around the eye. This is because your body mistakes the tissue around your eyes as a foreign invader and attacks it. This condition is called an autoimmune disease.

As a result, the eye muscles may become stiff, causing double vision, or even bulging the eyes.

Thyroid eye disease is often associated with hyperthyroidism and takes up about 90% of the cases.

What are the risk factors of thyroid eye disease?

Anyone may develop TED as it is an autoimmune condition. However, some risk factors that may increase the chances of contracting it are:

Having a family history of Graves’ disease.
Women are more prone to develop Graves’ disease.
Grave’s disease usually develops in people before the age of 40.
People with other conditions such as Type 1 Diabetes or Rheumatoid Arthritis may have a higher risk of contracting this disease.
Pregnancy or recent childbirth among women with a genetic history increases their risk.
Cigarette smoking may affect the immune system, thus increasing the risk of Graves’ disease.

What are the symptoms of thyroid eye disease?

The symptoms may begin as early as 6 months.

Here are some of the common symptoms of TED:

The front of the eyes may feel dry.
Bulging of the eyes that appear as the person is staring or have a startled appearance. This condition is also called exophthalmos by doctors.
Aching at the back of the eyes, which is worse in the mornings when looking up, down or sideways.
The front of the eyes may become red and irritated since the eyes may lack sufficient lubrication.
As the muscles of the eye become too swollen, you may start having double vision, also known as diplopia.
Mild sensitivity to light.
Swelling and redness of the eyes.
Difficulty moving the eyes.
Vision may become blurred, and colours may appear less vivid in advanced stages.

What are the first signs of thyroid eye disease?

The early signs of TED may include itching, watery or dry eyes and a feeling of the grittiness of the eyes.

Patients may also notice swelling around the eyelids or in the front of the eye.

Can you go blind from thyroid eye disease?

As the symptoms build up, many patients may have the fear that they may become blind. Thyroid eye disease may cause secondary glaucoma and leads to blindness.

However, it is important to get yourself treated immediately if you have noticeable symptoms in order to avoid any permanent damage to the eye.

How is thyroid eye disease diagnosed?

For those who have been diagnosed with hyperthyroidism, the doctors may conduct periodic physical examinations to look for any signs of thyroid eye disease.

If suspected, further tests as mentioned below are then conducted to diagnose TED:

Blood tests are required to confirm and back up the diagnosis. The test will show how well the thyroid gland is functioning by measuring its hormones in the bloodstream.
CT or MRI scans are carried out to scan the muscles of the eyes. This is used to show which tissue has been affected most.
Doctors may also carry out tests on the eyes to assess vision. This includes identifying colours correctly and checking for peripheral vision. They may also carry out an eye movement test to see if any muscle has been affected. These tests/assessments will be repeated throughout the course of the disease.

What are the stages of thyroid eye disease?

There are two stages or phases of TED:

The first is the active or acute phase. This phase lasts for about 6 months to up to 2 years and is marked by inflammation of the eyes. During this time, symptoms appear suddenly but may get worse over time. It is recommended to get it treated as soon as the first signs are noticed.
The second or inactive phase happens when the inflammation and other symptoms have subsided. However, this does not mean that it will not come back. TED is an ongoing disease, and thus it is always important to treat it immediately.

What are the treatment options for thyroid eye disease?

As there are two phases or stages in TED, the treatment given is also based on this.

The first or active phase is the time when the disease should be treated and monitored carefully. At this stage, treatment focuses on preserving the eyesight and integrity of the cornea as well as treating double vision.

Artificial tears are used throughout the day to relieve patients from dry eyes, and gels or ointments at night.

If the disease progresses, patients may be prescribed immunosuppressive medicines. These may help to dampen the immune system that’s producing the abnormal antibodies.

In the second phase of the disease, patients may require surgery to correct double vision and to reduce eyelid retraction.

Surgery may also help in returning the eye to a normal position within the socket.

How to prevent thyroid eye disease from getting worse?

The following measures may help to prevent TED from getting worse:

Stop smoking if you are a smoker. It may be difficult but speak to your doctor and enrol in programmes that may help you to quit the habit.
Avoid fluctuations in thyroid levels. Get regular blood tests to check for thyroid hormone levels and make sure to take the prescribed medications timely.
Avoid radioiodine treatment if you have active TED and if you are a smoker.
Get selenium supplements. Recent evidence suggests that patients with mild TED may benefit from it if taken over a period of 6 months.

Book an appointment at Pantai Hospitals

Thyroid eye disease not just affects the physical health of the patients but may also impact their emotional state and social well-being. It is, therefore, important for those at risk to get regular screenings by checking their thyroid levels periodically.

Learn about the various treatment options and Ophthalmology services available at Pantai Hospitals, Malaysia.

Pantai Hospitals have been accredited by the Malaysian Society for Quality in Health (MSQH) for its commitment to patient safety and service quality.

References

Thyroid eye disease, Available at: https://www.yourhormones.info/endocrine-conditions/thyroid-eye-disease/ [Assessed on: 15 March 2022]

What is thyroid eye disease, Available at: https://www.webmd.com/eye-health/graves-eye-defined [Assessed on: 15 March 2022]

Thyroid eye disease, Available at: https://patient.info/hormones/overactive-thyroid-gland-hyperthyroidism/thyroid-eye-disease [Assessed on: 16 March 2022]

Thyroid eye disease (TED), Available at: https://www.btf-thyroid.org/thyroid-eye-disease-leaflet [Assessed on: 17 March 2022]

Grave’s disease, Available at: https://www.mayoclinic.org/diseases-conditions/graves-disease/symptoms-causes/syc-20356240 [Assessed on: 17 March 2022]

Thyroid eye disease, Available at: https://patient.info/hormones/overactive-thyroid-gland-hyperthyroidism/thyroid-eye-disease [Assessed on: 17 March 2022]