Signs And Symptoms Of Graves’ Eye Disease
In Graves eye disease the tissue around the eye is attacked, and the result is inflammation and swelling, causing:
- Redness and pain
- Dry eye and irritation, occurring when the eyelids cannot close completely over bulging eyes
Progressive swelling may cause:
- Increased pressure inside the eye socket
- Pressure-pain or deep headache, which worsens with eye movements
The muscles around the eye are particularly susceptible to the attack of lymphocytes. As they tighten and lose their ability to stretch, these symptoms can occur:
- The eye is pushed forward in its socket causing a staring appearance
- Restriction of the eyes normal movements, resulting in double vision
As symptoms build, many patients fear they will lose their vision. Fortunately, patients almost never go blind from Graves eye disease.
Are There Any Complications From Thyroid Eye Disease
Most people do not develop permanent complications. However, where treatment is delayed or where the thyroid eye disease has been severe, there can be lasting effects. They are also more likely in older people, in those who smoke and in people with diabetes. Possible complications include:
Complications from the disease
- Damage to the clear window of the eye .
- Permanent squint or double vision .
- Damage to the nerve of the eye, resulting in poor vision or colour appreciation.
- Altered appearance .
Complications from treatment
- Side-effects from the immunosuppressive medicines.
- Side-effects from the surgery:
- New double vision .
- Loss of vision .
- There are some other very rare complications that your surgeon will talk you through.
Thyroid Eye Disease Center
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The eye changes associated with thyroid disease are referred to as Thyroid Eye Disease . Your doctor may also use the term Thyroid Associated Orbitopathy . Although TED is seen in all types of thyroid disorders, it is most common in patients that are or were hyperthyroid. It also rarely occurs in those who are hypothyroid and even when there is an absence of thyroid abnormalities in the body.
Thyroid disease can cause multiple eye problems. These include redness and swelling, double vision, decreased vision, eyelid retraction , and a bulging of the eye itself. It is important to realize that if one of these occurs, it does not mean you will necessarily get all the other symptoms too.
Eye problems will usually occur and frequently change in type or severity for between six months and two years. Once stabilized, it is unusual for the eyes to start changing again. Some patients are left with permanent changes, and in others the eyes return to normal. A great deal can be done to improve these conditions with medical treatment, although some patients will need surgery to help ease their issues.
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How Does It Affect The Eyes
The condition can make your eyes bulge. Thatâs because it mostly affects your orbit, the area in your skull where your eyeballs sit. Immune cells can cause inflammation that make the muscles, fat, and other tissue in this area expand.
If thereâs a lot of swelling, you may not be able to close your eyes all the way.
You may also get other symptoms, such as:
- Redness in the whites of your eyes
- Irritation, like thereâs dirt in your eye
- Pain and pressure
What Is The Outlook For Thyroid Eye Disease
Thyroid eye disease is a temporary but drawn-out illness which fades away by itself. The inflamed period tends to last months to years , after which there is a healing response. For most people the condition will be mild, needing lubricants and regular assessments only. For those with more severe disease, the outlook depends on how early it is diagnosed and how intensive the treatment is. About 1 in 4 people with severe disease will end up with reduced eyesight.
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How Long Does It Take To Work
How long Tepezza takes to improve your TED may depend on certain factors, including the severity your condition.
In two clinical studies, after 24 weeks of Tepezza treatment, some people had reduced symptoms of TED. Their improvements included:
- a complete resolution of double vision
In these studies, some people had an improvement in certain symptoms after just 6 weeks. However, for the drug to work as its meant to, you should receive one dose every 3 weeks for a total of eight doses. So, this means your Tepezza treatment will last about 5 months.
If you have questions, talk with your doctor about when you can expect results from Tepezza treatment.
The Tepezza dosage your doctor prescribes will depend on several factors. These include:
- your body weight
- whether its your first dose of the drug
The following information describes dosages that are commonly used or recommended. However, be sure to follow the Tepezza treatment plan your doctor prescribes for you. Your doctor will determine the best dosage to fit your needs.
What Is Graves Ophthalmopathy
GO is a condition that occurs when the immune system attacks the muscles and other tissues around the eyes.
The result is inflammation and a buildup of tissue and fat behind the eye socket, causing the eyeballs to bulge out. Rarely, inflammation is severe enough to compress, or push on, the optic nerve that leads from the eye to the brain, causing vision loss.
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Other Types Of Treatment
If you develop double vision , you may be referred to a specialist health professional who manages problems with eye muscles . They may give you modified glasses that block off vision from one eye or put a special cover, called a prism, over one side to stop the diplopia.
Treatment using radiation may be used in some places on some people. The aim is to reduce the swelling in the eye. It is used alongside other forms of treatment.
A number of new treatments are being investigated.
Your doctors will also treat any abnormality of thyroid function with antithyroid medicines. This is usually with tablets but may also include radioactive iodine or, uncommonly, surgery to the thyroid gland. We know that good control of the thyroid function helps lessen the severity of thyroid eye disease. See the separate leaflet called Antithyroid Medicines.
What Are The Signs And Symptoms Of Thyroid Eye Disease
Early symptoms of thyroid eye disease are itching, watering or dry eyes and a feeling of grittiness of the eyes. Some people may notice a swelling around the eyelids and sometimes the front of the eye becomes swollen. The eyelids may become uneven in size and they may seem to sit further back on the eyeballs . Patients may experience prominent or protruding eyes , and in more advanced cases, double vision.Rarely, patients may not be able to completely close their eyes due to protrusion of the eyeball. This exposes the cornea to damage from dirt, causing reduced vision. Sometimes the swelling at the back of the eyes can press on the nerve behind the eye causing pain, washed out colour vision and reduced vision which, if untreated, can lead to blindness.
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Problems Associated With Thyroid Eye Disease
Dry irritated eyes
TED may cause you to experience dry, irritated and often teary eyes. This is usually due to the eyelids retracting and or protruding. When the eyelids do not close completely at night, the cornea dries out and becomes quite uncomfortable. The use of lubricating ointment for the eye at night and artificial tears during the day can provide a great deal of relief. Do not be afraid to use the tears frequently, as much as every 1/2 to 1 hour if necessary.
TED can cause swelling, irritation and scarring of the muscles that move the eyes. This can lead to double vision. Double vision may not be present all the time, sometimes it is noticeable only when looking in certain directions, while in other patients it is always present. Often the amount of double vision will change week to week. At times it can disappear completely without treatment. Once the double vision has been stable for at least several months, surgery can be performed to correct it if necessary. Dr. Dailey will refer you to a referring provider for the surgery.
The Thyroid Gland And Important Terms
Thyroid Gland: The thyroid gland is located in the front of your neck. It produces thyroid hormones that are sent to the blood and carried around to other parts of your body. These hormones help your body use energy, stay warm and keep the brain, heart, muscles, and other organs working normally. The thyroid gland can become overactive or underactive . This is most often due to an autoimmune disease in your body.
Hyperthyroidism: Hyperthyroidism is a condition where the thyroid gland is stimulated by the immune system to produce more thyroid hormones than are needed by the body. Symptoms may include weight loss, nervousness, irritability, increased perspiration, fast heart rate, hand tremors, difficulty sleeping, thinning of the skin, brittle hair, and frequent bowel movements.
Hypothyroidism: Hypothyroidism is a condition where thyroid gland function is blocked by the immune system and not enough thyroid hormone is produced for the bodys needs. Symptoms may include feeling cold and tired, having drier skin, becoming forgetful and depressed, and having constipation.
Autoimmune disease: If you have an autoimmune disease, your immune system mistakenly attacks your body. Autoimmune diseases can affect many parts of the body. The cause of autoimmune diseases is largely unknown.
The Thyroid Gland
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Drug Forms And Strengths
Tepezza comes as powder inside single-dose vials. Each vial contains 500 milligrams of the active drug, teprotumumab.
Your healthcare provider will use the powder in the vial to make a solution. Then, theyll give the Tepezza solution to you as an intravenous infusion.
Tepezza infusions typically last 60 to 90 minutes.
Generic Or Biosimilar Version
Tepezza is only available as a brand-name, biologic medication.
Biologic drugs dont have generic forms. Instead, they may sometimes have approved biosimilar forms. However, Tepezza doesnt have an approved biosimilar.
Biosimilars are drugs that are similar to brand-name biologics . Unlike generics, which are made for drugs made from chemicals, biosimilars arent exact copies of their parent drug. Because biologics are made using living organisms, its not possible to copy them exactly.
However, approved biosimilars are considered to be just as safe and effective as their parent biologic. And they typically cost less than their parent drug.
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What Are The Longer
With the correct treatment, thyroid eye disease can be well managed and patients can live full and active lives. Most of the effects of the thyroid eye disease will settle with time and when thyroid function is stabilised. Patients taking carbimazole tablets to treat hyperthyroidism may need to take them daily for life, although definitive treatment of the overactive thyroid gland with radioiodine or surgery is generally preferred, once the eye disease has settled down. Regular blood tests should be carried out to monitor thyroid hormone levels and the dose of carbimazole adjusted accordingly. However, there are other treatment options such as thyroidectomy or radioiodine treatment that can be considered once the eye disease has settled down.
The changes in the physical appearance of the eyes can have a psychological effect on the individual, causing low self-esteem. The long-term consequences of the disease, even after the thyroid has settled down, may be difficult to accept. Some patients may have a permanent change to their appearance, which may require surgery. Very rarely, there is a permanent loss of vision this can happen if the disease is left untreated at the sight-threatening stage.
Patients should stop smoking as this is known to aggravate the condition. Sunglasses may be necessary even when indoors. If double vision is not corrected, driving will be dangerous. Patients should discuss any concerns with their doctor.
Thyroid Eye Disease May Slow Down Over Time But That Doesnt Mean It Goes Away
The acute phase is followed by the chronic phase of TED. You may have heard your doctor refer to this phase as the inactive phase of TED. However, that doesnt mean your condition has gone away. You may still have symptoms during the chronic phase.
Only a TED Specialist can determine which phase of TED you are in, but there are a few signs to watch for that may signal you are entering the chronic phase:
- Inflammation has stopped or slowed
- Redness has decreased or gone away
- Eye bulging hasnt gotten worse
Inflammation that began during the acute phase can cause scar tissue to build up over time. This can cause damage to the eyes, leaving you with ongoing symptoms like eye bulging, eye pain, eye pressure, double vision and misaligned eyes, if not treated.
Remember, TED is an ongoing disease. Just because some symptoms slow down, does not mean they will go away. Its even possible for symptoms to return, or flare up, if left untreated.
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Use Artificial Tear Eye Drops
Symptoms of dry eye can be managed by using eye drops to moisten your eyes and they can usually be used frequently or as much as needed.
Also trying to avoid, or protect your eyes in windy or dusty environments, can help, as these conditions might irritate your eyes this can be done by wearing glasses or protective eyewear.
You may also find that taking regular breaks when doing activities such as reading, watching television and using computer screens can help keep your eyes feeling more comfortable.
Eye Symptoms And Treatment
Thyroid eye disease can affect many different parts of the eye and surrounding tissues. Inflamed lacrimal glands may cause wet eyes or dry eyes, and these can both happen in the same patient at different times. Lubrication with eyedrops or ointment can help to soothe this irritation. The abnormal immune reaction causes swelling in the tissues of the eyelids and orbit which can make the eyelids look puffy or as if the person has “baggy” eyelids. This can also create a sensation of pressure around the eyes. The swelling can be surgically altered to bring the lids back to a more normal shape.
The muscles in the eyelids tighten and pull the upper lid up and the lower lid down. This creates a startled look with too much of the whites of the eyes showing. This also can be surgically improved. The muscles which control movement of the eyes may be increased in size by the swelling. This can create problems with double vision and focusing. Prism glasses may be helpful, and this can also be improved by surgically moving the eye muscles.
The treatment options for vision-threatening problems in thyroid eye disease include corticosteroids or other anti-inflammatory medications, radiation and surgery. A combination of these may be necessary to protect vision. Most people with thyroid eye disease do not get corneal ulcers or optic neuropathy, but it is important to understand the symptoms so you know when to seek help.
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Does Tepezza Cure Thyroid Eye Disease
No, Tepezza doesnt cure thyroid eye disease . However, treatment with Tepezza may help relieve certain symptoms of this condition.
Its not fully clear how long these effects last after stopping Tepezza treatment. Some people who used Tepezza kept their improvement in certain TED symptoms for 1 year after stopping the studies.
Talk with your doctor to find out what you can expect with Tepezza treatment.
What Is Graves’ Eye Disease Or Thyroid Eye Disease
Graves’ eye disease, also known as thyroid eye disease, is an autoimmune condition in which immune cells attack the thyroid gland which responds by secreting an excess amount of thyroid hormone. As a result, the thyroid gland enlarges and excess hormones increase metabolism. The hypermetabolic state is characterized by fast pulse/heartbeat, palpitations, profuse sweating, high blood pressure, irritability, fatigue, weight loss, heat intolerance, and loss of hair and alterations in hair quality. When the immune system attacks the tissues around the eyes, it causes the eye muscles or fat to expand.
The eyes are particularly vulnerable to Graves’ eye disease, because the autoimmune attack often targets the eye muscles and connective tissue within the eye socket. This likely occurs because these tissues contain proteins that appear similar to the immune system as those of the thyroid gland. Ocular symptoms can range from mild to severe but only 10-20% of patients have sight threatening disease. Another tissue that can also be involved in the immune attack of Graves’ eye disease is the skin of the shins.
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Closing In On More Effective Treatments For Thyroid Eye Disease
Needless to say, if you are among the estimated 20,000 patients experiencing active TED in any given year,3 it will come as a huge relief to learn about some effective new treatments. Since there is as yet no treatment for thyroid eye disease, it behooves you to stay alert for new treatments that are approved to manage thyroid eye disease as you may benefit from advances in treatment as time goes on.
Results of the OPTIC trial suggests that, finally, we may be closing in a the first effective therapy.4
The drug, teprotumumab, for example, is a biologic drug made of human monoclonal antibodies. The effectiveness of this medication appears very good following eight doses of this medication given intravenously to patients with TED over 24 weeks.4
An improvement in symptoms was experienced by more than 80% of the participants,3 says Raymond Douglas, MD, director of the orbital and thyroid eye disease program at Cedars-Sinai Medical Center in Los Angeles, California, who presented the data at the AACE 2019 meeting in San Francisco, California.
When the trial was designed, Dr. Douglas and the research team werent sure how much of the drug would be enough. We figured that the inflammation might get better, but the more problematic cases might require more treatment .