Summary about Disease
Thyroid eye disease (TED), also known as Graves' ophthalmopathy, is an autoimmune condition where the immune system mistakenly attacks the tissues around the eyes. This inflammation can affect the eye muscles, eyelids, tear glands, and fatty tissues behind the eye, leading to a variety of symptoms that can impact vision and appearance. TED is most commonly associated with Graves' disease, an autoimmune disorder that causes hyperthyroidism (overactive thyroid). However, it can also occur in people with normal or even underactive thyroid function.
Symptoms
Symptoms of TED can vary in severity and may include:
Dry, gritty, or irritated eyes
Excessive tearing
Redness and swelling of the eyelids and conjunctiva (the membrane covering the white part of the eye)
Bulging of the eyes (proptosis or exophthalmos)
Double vision (diplopia)
Difficulty closing the eyelids completely
Pain or pressure in the eyes
Sensitivity to light (photophobia)
Blurred vision or decreased vision
Causes
TED is caused by an autoimmune reaction. In most cases, this reaction is linked to Graves' disease, where antibodies target the thyroid gland, causing it to overproduce thyroid hormones. These antibodies also bind to receptors on cells around the eyes, triggering inflammation and tissue damage. The exact mechanisms that lead to this autoimmune response are not fully understood.
Medicine Used
Treatment for TED aims to reduce inflammation and manage symptoms. Medications may include:
Artificial tears and lubricating ointments: To relieve dry eye symptoms.
Steroids (e.g., prednisone): To reduce inflammation. Usually used for short periods due to side effects.
Teprotumumab (Tepezza): An antibody that targets the IGF-1R receptor on cells around the eyes, reducing inflammation and proptosis.
Selenium supplements: May be helpful in mild cases.
Immunosuppressants (e.g., methotrexate, azathioprine): Used in some cases to suppress the immune system.
Thyroid medication: To manage thyroid hormone levels (if Graves' disease is present).
Is Communicable
No, thyroid eye disease is not communicable. It is an autoimmune disease, meaning it is caused by the body's own immune system attacking itself. It cannot be spread from person to person.
Precautions
While there are no specific precautions to prevent TED in individuals with Graves' disease, managing thyroid function is crucial. Precautions to manage TED include:
Quit smoking: Smoking worsens TED.
Protect your eyes from sun and wind: Wear sunglasses.
Keep your eyes lubricated: Use artificial tears frequently.
Elevate your head while sleeping: To reduce swelling around the eyes.
Manage thyroid levels: Work with your doctor to maintain stable thyroid hormone levels.
How long does an outbreak last?
TED typically has two phases: an active inflammatory phase and a stable or inactive phase. The active phase usually lasts for 6 months to 2 years. During this phase, symptoms worsen. The inactive phase follows, where symptoms stabilize or improve. However, some symptoms, like proptosis or double vision, may persist.
How is it diagnosed?
Diagnosis of TED usually involves:
Physical examination: Including an eye exam to assess eye movement, proptosis, eyelid retraction, and visual acuity.
Blood tests: To measure thyroid hormone levels (TSH, T3, T4) and thyroid antibodies.
Imaging studies: Such as CT or MRI scans of the orbits to assess the eye muscles and other tissues around the eyes.
Visual field testing: To check for any visual field defects.
Timeline of Symptoms
The timeline of TED symptoms can vary, but it generally follows this pattern:
Early stage: Dry eyes, mild irritation, and eyelid swelling may appear first.
Active phase: Over the next few months to a year, inflammation worsens, leading to proptosis, double vision, and pain.
Plateau phase: After 6 months to 2 years, the inflammation starts to subside, and symptoms stabilize.
Inactive phase: Symptoms may gradually improve, but some changes like proptosis may remain.
Important Considerations
Early diagnosis and treatment are essential to minimize long-term complications.
Management of TED requires a multidisciplinary approach involving endocrinologists, ophthalmologists, and sometimes other specialists.
Even after the active phase, ongoing monitoring is important to manage any residual symptoms or complications.
Surgical options, such as orbital decompression, strabismus surgery, or eyelid surgery, may be considered to correct persistent problems after the active phase has ended.
Psychological support may be helpful, as TED can affect appearance and self-esteem.