Hyperthyroidism - Thyroid Eye Disease
Thyroid eye disease is also known as Graves' ophthalmopathy and is associated with Graves' disease (an autoimmune disease which causes an overactive thyroid) and sometimes with Hashimoto's thyroiditis (an autoimmune disease which causes an underactive thyroid). However people with thyroid eye disease may not necessarily have autoimmune thyroid disease, which leads researchers to think that thyroid eye disease and autoimmune thyroid disease are two separate diseases. Sometimes the changes in the eyes may be noticeable years before or after a person is diagnosed with Graves' disease.
Symptoms/Signs of Thyroid Eye Disease
- Sore "gritty" dry eyes (inability to wear contact lenses)
- Pain when moving the eyes (looking up, down and sideways)
- Red eyes/eyelids
- Pressure behind the eye
- Lid retraction (stare)
- Bulging eyes (caused by swelling in the eye socket (orbital tissues)
- Double vision
- Photophobia (light sensitivity)
- Reduced vision in severe cases
The TSH receptor antibodies found in Graves' disease are also found in people with thyroid eye disease and TSH receptor antibodies have been found in the orbital tissues (eye socket). Researchers don't know what role these antibodies play in thyroid eye disease. No specific gene has been identified either. It is possible that multiple genes are responsible for thyroid eye disease.
The diagnosis can be based on clinical grounds. Typical features are usually fairly obvious. If unsure then the following tests may be performed as well;
- Thyroid function test including TSH, free T4 and free T3
- Thyroid antibodies including TPO (thyroid peroxidase), anti-thyroglobulin and thyroid stimulating antibodies
- Thyroid uptake scan
- Orbital computed tomography
- Magnetic resonance imaging
Treatment for thyroid eye disease is usually managed by an ophthalmologist and thyroidologist. Unfortunately the treatment for thyroid eye disease is often disappointing. Smoking is a risk factor in developing thyroid eye disease and research has also shown that smokers respond poorly to treatment. If no treatment is given then the condition may improve on its own. It may take a few months or up to 3 years for the disease to run its course, but generally the condition will partially or completely improve. If the disease has been inactive for six months, then there is a good chance that the disease will not reoccur. In some cases the disease may reoccur if thyroid hormone levels are poorly controlled. Radioactive iodine (treatment for Graves' disease) can aggravate existing thyroid eye disease or it can cause a flare up and is therefore not recommended when you suffer from both Graves' disease and thyroid eye disease. Treatment options are as follows;
Most people only need supportive care. If your eyes are dry and feel "gritty" then you can get lubricating eye drops from the pharmacy or you could try propping up the bed (by elevating the head). Good quality sunglasses can help with light sensitivity and cool compresses can temporarily reduce the inflammation. If you were diagnosed with autoimmune thyroid disease (Graves' disease or Hashimoto's thyroiditis) then establishing normal thyroid function is important as well.
High doses of steroids are usually offered to reduce the inflammation for 4-6 weeks in the active phase of the disease, but are often unsatisfactory and may come with other serious side effects especially if used for a long period of time.
The effectiveness and safety of this treatment is being questioned by researchers. This controversial treatment can produce unwanted side effects, which may not be obvious for years. These include;
- Radiation retinopathy (vision threatening complication)
Radiotherapy is not recommended for diabetic people with retinopathy. In some cases steroids are used in combination with orbital radiotherapy.
Surgery is usually only recommended for severe cases. The usual procedure is called inferior orbital decompression, which may be followed by eye muscle surgery a few months later. Eyelid surgery can be done at a later date to improve the appearance and function of the eyes.
Copyright © 2011-2018 Monique Atkinson
Disclaimer The information provided is for educational purposes only and is not intended to be medical advice. The contents must not be relied upon in place of advice and treatment from a qualified medical practitioner. THYROID WA SUPPORT GROUP INC. and the author disclaim any liability whatsoever.