Dr Ben Wild
Overview |
Thyroid eye disease (TED), aka Grave’s disease, refers to a condition where, instead of the thyroid gland being stimulated by thyroid stimulating hormone from the pituitary gland in the brain, it reacts to destructive antibodies created by the immune system. In TED, these antibodies can also attach to ocular tissues such as orbital fat, lacrimal glands, and eye muscles. This can cause swelling of these tissues up to 8x their normal size. This is usually seen in women in their 4th to 5th decade of life who smoke and is accompanied by weight loss despite healthy appetite, increased bowel movements, nervousness, irritability, palpations, and/or weakness and fatigue.
A frontal view of a healthy eye.
There are 2 stages of TED. Stage 1 refers to the inflammatory stage where the antibodies attack orbital tissues and cause swelling. This stage is accompanied by pain, swelling of the eye, bulging of one or both eyes, loss of vision, double vision, and more. Stage 2 refers to the fibrotic (scarring) stage. The eye is no longer inflamed, is usually clear and painless, but the scarring usually results in restricted eye movements and double vision.
Frontal view of an eye with active severe thyroid eye disease.
Thyroid dysfunction can be diagnosed after blood work showing elevated T3/T4 (thyroid) levels yet low TSH levels. TED is diagnosed after thyroid dysfunction has been discovered and MRI/CT scans of the orbits show swelling of orbital tissue.
Signs and Symptoms |
Signs
Red eyes, swollen eyes, swollen lids, bulging eyes, eyelid retraction, difficulty closing eyes.
Symptoms
Pain, loss of vision, double vision, grittiness, tearing, light sensitivity.
Causes and Risk Factors |
Causes
Autoimmune disorder (Grave’s disease).
Risk Factors
Smoking.
Prevention and Treatment |
Prevention
Have routine physicals with lab work by your family doctor, discontinue smoking, and seek treatment if thyroid levels are elevated.
Treatments
Stage 1 (inflammatory stage) | · Oral steroids or steroid injections. · Artificial tears. · Tape eyelids or wear an eye shield at night. · Topical anti-inflammatories. · Keep head elevated when sleeping. · Radiotherapy (to remove functioning thyroid) · Surgery (thyroidectomy). |
Stage 2 (fibrosis/scarring stage) | · Orbital decompression (remove some of the tissue behind the eye. · Strabismus surgery (re-align eyes). |
Prognosis |
TED is a vision threatening condition. If the orbital tissue swells too much, it will compress the optic nerve and cause permanent blind spots. It can also result in the cornea failing, resulting in scarring and, again, vision loss. Additionally, it can cause potentially permanent bulging eyes (proptosis) and double vision. Prompt diagnosis and treatment can drastically lower the likelihood of vision loss.
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