Thyroid Eye Disease

Thyroid eye disease (TED)- also known as Graves Orbitopathy or Thyroid Associated Orbitopathy- is an autoimmune condition of the soft tissue such as the fat and muscles surrounding the eyes. The disease is characterized by a period of inflammation and swelling of these tissues, followed by a healing response. Our body’s immune system usually fights off infection but in an autoimmune disease it attacks the body’s own tissues with antibodies. When an autoimmune attack starts on the thyroid gland, it responds by producing more of its hormones. At the same time the auto-antibodies attacking the thyroid gland also attack the tissues around the eyes. We often term this as

“The Thyroid and your eyes are victims of the same disease”.

As the soft tissue around the eye becomes inflamed, some of the following problems can occur:

1. The eyelids become puffy and red (lid swelling).
2. The muscles of the eyelids contract, producing a staring appearance (lid retraction).
3. The muscles and fat surrounding the eye swells, pushing the eyes forward causing a bulge (exophthalmos).
4. Lid retraction (staring look) and exophthalmos (protrusion of eyeballs) make the dry eye symptoms worse.
5. The swelling of the muscles which move the eyes produce unequal movements and double vision (diplopia).
6. The orbits may become painful, particularly on eye movement.

In some patients who have firm tissue, the eyes may not bulge forward. This results in the pressure inside the orbit increasing which in turn compresses on the optic nerve and causes sight problems. The optic nerve carries messages from the eye to the brain and can be damaged by this increase in pressure.

Smoking history is very important in TED because it is associated with poor prognosis and poor response to treatment.

With regard to treatment, a thorough work up needs to be done before embarking on medical or surgical management

What is important to understand in the pathophysiology of Thyroid eye disease is that Hyperthyroidism does not cause Thyroid eye disease. Both conditions are caused by the underlying immune dysfunction. A person with Thyroid eye disease may be Hyperthyroid (high levels of Thyroid Hormones, Hypothyroid (low levels) or even Euthyroid (normal levels). TED is a systemic disease and not a local disease.

The standard of care today in the active stage of the disease is high dose pulsed Intra-Venous Methyl Prednisolone (IVMP). This injection steroids modality has been proven to be superior to oral steroids by numerous studies done.

The success of TED treatment is based on team work of a number of sub-specialists- an Oculoplastic surgeon, Immunlogist, Otorhinolaryngologist, Strabismus specialist, Orthoptist, Hepatologist and a Cardiologist. The primary physician in the case of TED is the Oculoplastic Surgeon.

Any specific questions you might have you can directly message me or ask in the comments section of this article.

I do not have any financial interests to declare regarding the above article and it is intended to educate the general public including medical professionals about eye conditions.

The above article is based on an answer I wrote on Quora

What is Thyroid Eye Disease?