Thyroid eye disease (TED) is a rare eye condition characterized by progressive inflammation of and damage to the muscles and soft tissues in and around the eyes, especially the extraocular muscles (the muscles present in the orbit but outside the eyeball), connective, and fatty tissue. TED is also known as thyroid-associated ophthalmopathy (TAO), thyroid orbitopathy, Graves’ orbitopathy, or Graves’ ophthalmopathy (GO). The disease often appears suddenly with endocrine and ophthalmic symptoms impairing normal life. TED can cause facial disfigurement affecting the quality of life and daily function of patients.
Treatment of TED involves medications for controlling the symptoms; protecting the eyes; maintaining optimal thyroid hormone levels by using oral antithyroid medicine (methimazole and propylthiouracil), radioactive iodine, medications to suppress the immune system, and vitamin supplements such as selenium; and performing thyroidectomy (thyroid removal) and surgery to restore the function and appearance of the eyes (reconstructive orbital or eyelid surgery may be done).
Phases of thyroid eye disease
There are two phases of thyroid eye disease (TED):
- The active stage: It is the period in which progressive inflammation, swelling, and tissue changes occur, and this stage typically lasts for about 6 months to 2 years.
- The inactive or burnt-out stage: It is the stable phase when active inflammation settles down, and the disease progression stops. In some patients, the eyes return to normal, whereas in others, permanent changes such as double vision and bulging eyes may remain.
What causes thyroid eye disease?
Thyroid eye disease (TED) is caused by an autoimmune process in which the body sees part of itself as foreign and reacts to it as it would to any bacteria or viruses.
The immune system attacks both the thyroid and tissues around the eye. Although TED is seen in all thyroid disorders, it is more often associated with hyperthyroidism or Graves’ disease.
Patients with TED produce antibodies that bind to the fibroblast cells (a type of connective tissue making the cells) within the eye socket. This causes the fibroblast cells to produce chemical signals and release biological materials that lead to swelling and congestion in and around the eye socket. This causes inflammation and swelling of the fat and muscle tissues around the eye causing bulging of the eyes, retraction of the eyelids, and double vision.
SLIDESHOW
Hyperthyroidism: Symptoms, Treatment, Medication See SlideshowWhat are the signs and symptoms of thyroid eye disease?
Some common signs and symptoms of thyroid eye disease (TED) include:
- Red and puffy eyelids that are more obvious in the morning
- Irritation and redness of the eyes
- Dry eyes (watering, grittiness, and soreness)
- Corneal scarring
- Bags under the eyes
- Eyelid retraction (the upper eyelid rises to a higher position making the white of the eye more visible causing staring eyes)
- Exophthalmos or proptosis (bulging of the eyes)
- Difficulty in closing eyelids
- Strabismus (also called squint)
- Swelling or feeling of fullness in one or both the upper eyelids
- Blurring or dimming of vision due to optic nerve compression
- Painful orbits (eye sockets)
- Pain in or behind the eye, especially when looking up, down, or sideways
- Difficulty moving the eyes
- Diplopia (double vision due to pain or restricted eye movements)
- Discomfort to bright lights
- Pressure sensation with headache
https://www.asoprs.org/thyroid-eye-disease
https://emedicine.medscape.com/article/1218444-overview
Top What Is the Treatment of Thyroid Eye Disease? Related Articles
acetylcholine
Acetylcholine is a medication instilled into the eye during certain ocular surgeries to achieve rapid constriction (miosis) of the pupils for a short period. Common side effects of acetylcholine include clouding of the cornea, corneal swelling (edema), corneal decompensation, flushing, low blood pressure (hypotension), slow heart rate (bradycardia), shortness of breath (dyspnea), and sweating (diaphoresis). Consult your doctor before taking acetylcholine if pregnant or breastfeeding.Azopt (brinzolamide) ophthalmic suspension
Azopt is a prescription medicine used to treat the symptoms of ocular hypertension of open-angle glaucoma in adults. Serious side effects of Azopt include hives, difficulty breathing, swelling in your face or throat, fever, sore throat, burning eyes, skin pain, red or purple skin rash with blistering and peeling, eye pain or redness, swelling of the eyes, sensitivity to light, and others.cyclopentolate
Cyclopentolate is an ophthalmic solution administered in the eye to dilate the pupils for eye examination and diagnostic purposes. Common side effects of cyclopentolate include burning sensation in the eye, blurred vision, eye focusing difficulty (accommodation disturbance), increase in intraocular pressure, light intolerance, inflammation of the conjunctiva, burning sensation of the skin, hypersensitivity reaction, drowsiness, rapid heart rate (tachycardia), hyperreactive response in Down’s syndrome children, hyperactivity, impairment of coordination and balance (ataxia), incoherent speech, restlessness, hallucination, psychosis, and seizure.
Eye Cancer: Intraocular (Uveal) aMelanoma Treatment
Melanoma is a serious form of skin cancer that develops when the pigment-producing cells (melanocytes) that give the skin its color, which are also present in the eyes, become cancerous. When melanoma develops in the cells of the eye, it is known as intraocular melanoma. Treatments for intraocular melanoma include surgery, watchful waiting, radiation therapy, photocoagulation, and thermotherapy.glandular products
Glandular products are nutritional supplements used to enhance the function or mimic the effect of an organ. Glandular products can be used to treat hypothyroidism, low adrenal function, autoimmune disorders, adrenocortical insufficiency, hyperkalemia, ulcerative colitis, liver disorders, vascular insufficiencies, pancreatic disorders, and others. Common side effects of glandular products include allergic reactions, hyperthyroidism symptoms, iron overload, infection, and others.
Hyperthyroidism
Hyperthyroidism is an excess of thyroid hormone due to an overactive thyroid gland. Symptoms can include increased heart rate, weight loss, heart palpitations, frequent bowel movements, depression, fatigue, fine or brittle hair, sleep problems, thinning skin, and irregular vaginal bleeding.
Graves' disease is the most common cause of hyperthyroidism. Many other health problems or taking excess thyroid hormone medication can cause an overactive thyroid gland. Treatment for the condition is with medication, radioactive iodine, thyroid surgery (rarely), or reducing the dose of thyroid hormone. No diet has been shown to treat hyperthyroidism or its symptoms and signs.
iodine
Iodine is a trace mineral used by the body to produce thyroid hormones. Iodine is an essential component of thyroid hormones thyroxine (T4) and triiodothyronine (T3) produced by the thyroid gland. Excessive iodine may lead to reduced thyroid function (hypothyroidism) by feedback inhibition of thyroid hormone production and conversion of triiodothyronine (T3) to less active thyroxine (T4). Common side effects of iodine include metallic taste, fever, thyroid suppression, headache, joint pain (arthralgia), diarrhea, acne (high dose), hives (urticaria), fluid in lungs (pulmonary edema), swelling of tissue under the skin and mucous membranes (angioedema), and high blood count of eosinophil immune cells (eosinophilia).levothyroxine
Levothyroxine is a synthetic form of thyroid hormone used to treat hypothyroidism (underactive thyroid), myxedema coma, pituitary TSH suppression, and organ preservation. Common side effects of levothyroxine may include fatigue, increased appetite, weight loss, heat intolerance, fever, excessive sweating, increase in pulse rate, increase in blood pressure, irregular heart rhythm (arrhythmia), palpitations, rapid heartbeat (tachycardia), chest pain (angina pectoris), congestive heart failure, heart attack (myocardial infarction), and others. Consult your doctor if pregnant or breastfeeding.multivitamins, vision
Multivitamins for the eyes are a combination of vitamins, minerals, and other nutrients, used to maintain eye health and to prevent the development or worsening of age-related macular degeneration (AMD). Common side effects of eye vitamins include nausea, vomiting, diarrhea, gastrointestinal distress, and constipation. Consult your doctor if you are pregnant or breastfeeding. Multivitamins have no listed severe, serious, moderate, or mild interactions with other drugs.oxymetazoline ophthalmic
Oxymetazoline ophthalmic solution is an eye medication used to treat blepharoptosis, a disorder that causes the upper eyelid to droop, partially or fully blocking vision. Oxymetazoline ophthalmic is used to treat acquired blepharoptosis in adults, and not to be used for the treatment of congenital blepharoptosis in children. Common side effects of oxymetazoline ophthalmic include application site pain, transient stinging or burning of the eyes, eye irritation, dry eye syndrome, red eye (conjunctival hyperemia), blurred vision, corneal inflammation with pinpoint lesions (punctate keratitis), and headache. Excessive use of oxymetazoline ophthalmic can worsen ocular side effects and result in systemic absorption which can cause headaches, dizziness, lightheadedness, fainting, or blurred vision.Polyethylene Glycol 400/Propylene Glycol Ophthalmic
Polyethylene glycol 400/propylene glycol ophthalmic is a type of artificial tears used to treat the irritation and burning caused by dry eyes. Common side effects of polyethylene glycol 400/propylene glycol ophthalmic drops include eye irritation, temporary blurred vision, and mild burning or stinging. Use as indicated. Overuse of polyethylene glycol 400/propylene glycol eye drops can wash away natural tears and worsen the symptoms of dry eyes.potassium iodide
Potassium iodide is an oral medication that has been used for a long time as an expectorant to break up mucus and make it easier to cough up and eliminate phlegm. Potassium iodide is also used to inhibit thyroid hormone production in patients with an overactive thyroid (hyperthyroidism) and thyrotoxicosis. Common side effects of potassium iodide include nausea, vomiting, diarrhea, stomach pain, gastrointestinal irritation or bleeding, metallic taste, iodide poisoning syndrome (iodism), and others. Use of potassium iodide during pregnancy can cause fetal harm.tetrahydrozoline/zinc sulfate/hypromellose ophthalmic
Tetrahydrozoline/zinc sulfate/hypromellose ophthalmic is a combination medication used for the temporary relief of redness and discomfort in the eyes caused by dry eyes or minor irritations such as swimming, dust, smoke or smog. Common side effects of tetrahydrozoline/zinc sulfate/hypromellose ophthalmic include transient burning and stinging in the eyes, temporary dilation of pupils, temporary blurred vision, transient dryness of the eyes, rebound redness of the eyes, and increased pressure inside the eye (intraocular). Consult your doctor if pregnant or breastfeeding.thyroid desiccated
Thyroid desiccated is a dried form of thyroid, a naturally occurring hormone, used for replacement or supplemental therapy in people deficient in thyroid hormone (hypothyroidism). Common side effects of thyroid desiccated include chest pain, palpitations, irregular heart rhythm (cardiac arrhythmia), high heart rate (tachycardia), shortness of breath (dyspnea), abdominal cramps, diarrhea, constipation, vomiting, weight loss, increased appetite, excessive sweating (diaphoresis), hair loss (alopecia), fever, headache, heat intolerance, muscle pain (myalgia), cramps, impaired balance/coordination/speech (ataxia), tremor, and others. Consult your doctor if pregnant or breastfeeding.
Illustrations of Thyroid
The thyroid is a butterfly-shaped gland located in the front of the neck just below the Adams apple. See a picture of the Thyroid and learn more about the health topic.
Your Thyroid: Common Thyroid Problems and Diseases Explained
Learn about thyroid problems such as hyperthyroidism, hypothyroidism, thyroid cancer, and more. Discover symptoms and treatments for various thyroid problems.
Thyroid Quiz
Your unexplained change in weight could indicate a thyroid condition. Take the Thyroid Quiz to learn about common symptoms and treatments of overactive and underactive thyroid disorders.What Kind of Doctor Treats Thyroid Eye Disease?
Thyroid eye disease, also known as Graves’ orbitopathy or Graves' ophthalmopathy, is an eye condition that happens in a person with an overactive thyroid. Most eye surgeons (ophthalmologists) and hormone specialists (endocrinologists) will be in contact with an oculoplastic surgeon with experience in treating patients with thyroid eye disease.