Treating Thyroid Eye Disease
If you have thyroid eye disease, your treatment may be in several stages. This is because the condition tends to progress through 2 main phases:
- an “active” phase, when dryness and redness are prominent and you may be at risk of vision problems
- an “inactive” phase, when the condition has settled down, but you may be left with some long-term problems
The active phase can last for several months to 2 years.
What Is The Success Rate Of Surgery
At Moorfields Eye Hospital, we have shown that there is a significant improvement in patients overall quality of life following surgery for TED. Decompression surgery is very successful in reducing the bulging and prominence of the eyes, thus improving both the physical and psychological effects this disease has on patients.
In terms of complications, there have been some reported complications of partial vision loss however, I personally have never had anyone with loss of vision during or following surgery. I am one of the most experienced decompression surgeons in the UK, having performed and presented results of over 500 surgeries . I also run the TED clinic at Moorfield’s Eye Hospital where we have seen over 5,000 patients over 15 years.
I am confident and experienced in treating complex thyroid eye disease and performing appropriate and timely surgery, so patients can always expect the highest degree of care, attention and expertise in this area.
If you are suffering from thyroid eye disease and looking for a highly-experienced surgeon to help manage and treat your condition, visit Mr Jimmy Uddins Top Doctors profile and book a consultation with him.
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.
Read Also: Is Thyroid Test Fasting
Graves’ Disease Sometimes Affects The Eyes Too
Her thyroid blood testing confirmed what the doctor had suspectedChristine had Graves disease, an autoimmune disease that causes overactive thyroid function, or hyperthyroidism. Although she was prescribed medication to regulate her thyroid and restore her heart rate to normal, her doctor didnt address the fact that her eyes were red and puffy, and looked like they were protruding out of her eye sockets.
I did not realize that there were things I could do to help my eye symptoms until about three years into the disease, says Christine. Previously, I had been told that the annoying eye changes simply had to run their course. But during that time, things got much worse.
It wasnt until several years later that Christine sought treatment for her eyes. In addition to Graves disease, Christine learned that she also has
Graves ophthalmopathy, known more commonly as thyroid eye disease , which affects women 5 to 6 times more often then in men. Thyroid eye disease is an autoimmune condition arising in about half of those with Graves disease it causes the bodys immune system to attack the area behind the eye, causing the muscles and tissues to swell, causing the bulging appearance.
New Study: Breakthrough Drug Reduces Graves Eye Disease Symptoms
A clinical trial led by the University of Michigan Kellogg Eye Center offers hope for those with moderate to severe active TED. Patients had a significant reduction in the severity of symptoms after treatment with teprotumumab, a study drug the Food and Drug Administration designated a breakthrough therapy. Learn more about the results of this clinical trial.
Recommended Reading: T3 Dosage For Hypothyroid
What Eye Problems Can Graves’ Disease Cause
Graves disease is a serious health condition. In many cases, people with this disease can develop Graves ophthalmopathy.
When this occurs, various eye problems can appear. For example, you may develop the following:
- Caruncular edema
- Conjunctival redness
- Eyelid redness
- Motility restriction
However, it is important to remember that many of these eye problems are manageable with medications and treatments.
How Is Thyroid Eye Disease Treated / Managed
Thyroid eye disease in its active phase can last between one and three years. That means if it is left untreated, the inflammation may gradually decrease by itself but may cause damage to vision through the course of the disease. Sometimes, the changes caused by the enlargement of the tissues may not go away. The goal of treatment is to limit inflammation and swelling occurring during the active or inflammatory phase and to protect the front of the eye and prevent vision loss.
Thyroid eye disease is managed by a specialist eye doctor . Any underlying thyroid problems will be managed by your primary care doctor or by a specialist in the hormone systems of the body .
If a thyroid issue is suspected, evaluation and treatment are critical. The first priority is to restore your normal thyroid function. In addition, eye conditions should be examined and treated at the same time as your thyroid gland treatment. Eye problems may continue to progress even after your thyroid function returns to normal.
If you have thyroid eye disease, your eye doctor may recommend one or more of the following treatments to help soothe your eyes and improve your vision:
Cool compresses: Apply cool compresses to your eyes. The extra moisture and cooling effect may provide relief.
Sunglasses: When you have thyroid eye disease, your eyes are more sensitive to sunlight and UV rays. Wearing sunglasses helps protect them from both sun and wind.
Don’t Miss: Thyroid Np Side Effects
If Your Doctor Has Recommended Infusion Therapy Let Infusion Associates Help You
At Infusion Associates, we provide medically-prescribed infusion therapy for patients with chronic conditions in a welcoming and friendly environment. Our team of healthcare professionals is committed to making the experience as comfortable as possible. We always inform patients of any potential side effects and answer all their questions before starting treatment. In addition, we have a Registered Pharmacist on staff to make the process as seamless as possible.
If you would like to refer a patient to us or want to inquire about the treatments we offer, you can contact us by calling us at or filling out this form.
Ask Your Doctor If You Should Try A Selenium Supplement
Selenium is a nutrient thats important for normal thyroid hormone production. When people with mild Graves ophthalmopathy took 100 micrograms of selenium twice a day for 6 months, their disease didnt progress as quickly as in those who took a placebo, according to a study published in the New England Journal of Medicine. They also experienced an improvement in their quality of life.
Ilya Leyngold, MD, an ocular plastic surgeon at Duke Eye Center in Durham, North Carolina, cautions that this particular study was performed in Europe, where the soil is not rich in selenium. Americans generally get enough selenium through their diet already, according to the National Institutes of Health Office of Dietary Supplements, so supplementing may not be helpful. Plus, taking too much selenium can increase the risk of skin rashes, diarrhea, and other symptoms, along with increasing the risk of developing type 2 diabetes.
Recommended Reading: Apple Cider Vinegar For Thyroid
How Does Thyroid Eye Disease Affect Mental Health
TED can cause eye pain, double vision, loss of vision, and changes to your appearance which may impact your quality of life. The impacts of TED can lead you to experience to depression, anxiety, loss of independence, and reduced self-confidence. You may have a decreased desire to socialize with others, have trouble with productivity at school or work, and stop doing activities you once enjoyed.
To help support your mental health as you deal with TED:
- Talk to your doctor: Talk to your doctor about any changes to your emotional well-being. Ask questions on how TED will affect your daily life and work.
- Seek support: Seek out support groups of others who are going through TED. The Graves Disease and Thyroid Foundation offers support groups for people with Graves disease, thyroid eye disease, and other thyroid conditions. These groups can help you learn about your condition, share your experience, and find support.
- Connect with others: Stay connected friends and family to keep you from feeling isolated.
- Take time to enjoy life: Take part in activities or hobbies that make you happy.
- Exercise: Exercise can help symptoms of depression or anxiety and make you feel better. Talk to your health care professional to determine what exercise routine may work best for you, especially if you have changes to your vision due to TED.
To learn more, check out the following resources:
What Causes Graves Ophthalmopathy
In many cases, Graves disease is responsible for the development of Graves ophthalmopathy. Graves disease is an autoimmune disease in which the body overproduces thyroid hormones, and the immune system responds negatively.
Because thyroid hormones play a vital role in various body systems, the disease severity of Graves ophthalmopathy can differ significantly.
Additionally, Hashimotos thyroiditis may result in Graves ophthalmopathy. This disease, also known as chronic lymphocytic thyroiditis, is the most frequent cause of hypothyroidismin the United States.
The 2009 Amsterdam Declaration signed by more than 80 organizations suggested that incidence and morbidity caused by Graves ophthalmopathy could go down significantly via preventive measures.
These steps included identifying early warning signs, stopping smoking, facilitating earlier access to specialist care, and avoiding hypothyroidism after radioactive iodine administration.
Read Also: Does Fasting Affect Thyroid Blood Test
Physical Exam For The Thyroid
During a physical exam, your healthcare provider will:
- Touch your neck to see if the thyroid is larger than normal or if there are nodules.
- Check for increased blood flow in the thyroid, called a thrill, by palpating the area.
- Use a stethoscope to listen to the sound of increased blood flow in the thyroid, called a bruit.
The physical exam may also include checking your:
- Thyroid-stimulating hormone receptor antibody
- Anti-thyroid peroxidase antibody
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.
Tepezza: Infusion Therapy For Thyroid Eye Disease
Being diagnosed with any chronic medical condition is overwhelming. While finally knowing why you havent been feeling well opens the door to learning about treatment options, with this new chapter, you have to become familiar with a long list of medical terms. What is thyroid eye disease? Why is it treated with TEPEZZA? What is infusion therapy? Once you start getting answers to your questions, you may feel more confident about commencing treatment.
In The Second Installment Of This Two
Management of thyroid eye disease has shifted dramatically from conservative measuresobservation and surgeryto targeted biologic therapy with a focus on cosmesis and quality of life. Surgical innovations have also allowed for more profound results with significantly less risk of complications. Treatments for active-phase disease have also multiplied, which significantly affects quality of life for these afflicted patients.
Last month, in part one of this two-part series on TED, I discussed the keys to diagnosing TED. Here, in part two, Ill discuss the best techniques for managing patients with TED.
Figure. 1. Eyelid swelling and ocular redness in a patient with thyroid eye disease . Improvement in redness and swelling after orbital steroid injection .
Medical therapy can be a good initial, noninvasive way to manage certain patients with TED. Following are the pros and cons of the various medical approaches.
Steroids. Steroids are excellent for reducing symptoms in TED, but arent disease-modifying rather, they improve soft-tissue symptoms in the active phase until the body can pass into the stable phase of the disease.
Figure 2. Bilateral proptosis in a patient with thyroid eye disease . Dramatic reduction in proptosis seen after orbital decompression surgery .
Figure 4. Eyelid retraction with improvement in upper lid position after eyelid retraction surgery .
You May Like: Hypothyroidism Double Chin Caused By Thyroid
Overview Of Treatment Options
Corticosteroids are a mainstay of treatment in TED. The benefit derived from corticosteroid administration is due to anti-inflammatory and immunosuppressive effects. Unfortunately, a significant percentage of patients respond only partially , and recurrences upon dose reduction or cessation are not infrequent .
Treatment Modalities For Thyroid Eye Disease
Treatment options for TED generally depend on disease activity and severity .1,53 Active and inactive TED can vary in severity, typically described as mild, moderate-to-severe, or sight-threatening.1 In active, mild TED, ocular lubricants, sunglasses, and prisms are used for supportive management.10,53 For active, moderate or severe disease, a variety of treatment strategies are used, sometimes resulting in short-term relief. However, there is still an unmet need for disease-modifying treatments with an optimal safety profile and long-term benefits.1,2
Table 3 Current And Emerging Therapies For Thyroid Eye Disease
Recommended Reading: Double Chin Caused By Thyroid
What Are The Surgical Options
Surgery is used for aesthetic and functional rehabilitative purposes. We do it when the disease has burnt out and stopped progressing . There are four types of surgeries which can be used:
1. Decompression surgery removal of some of the bone and fat around the eye to allow the eye to fall back to a more natural position. This helps to improve the bulging appearance of the eyes and reduces the puffiness of the lids and lacrimal gland. This needs to be tailed to the disease type , eye movement problems, degree of proptosis, etc.
2. Squint surgery performed to improve double vision and correct a squint. It involves moving the muscles attached to the eye to a new position.
3 and 4. Lid surgery this is carried out to reposition the eyelids. If your eyes are particularly starey, lid surgery on both the upper and lower lids can help improve this. This can be done through an anterior or posterior approach. Modified blepharoplasty can help reduce swelling above the lids and brow, as well as reshape the eyelids.
Sometimes, decompression surgery and lid surgery can be combined. Lid reposition surgery is often very successful but occasionally, some people need a second or third operation to correct minor problems, as the results are not always predictable the first time around.
Use Lubricating Eye Drops
People with thyroid eye disease can have dry, irritated eyes, because theyre not able to blink properly. When this happens, tear glands produce fewer tears, which makes the eyes even drier. Lubricating drops are a great adjunct natural treatment for dry eyes, explains Dr. Rapoport.
When choosing artificial tears or lubricating drops, look for preservative-free tears. Preservative-free formulations reduce the risk of irritation, says Howard R. Krauss, MD, a neuro-ophthalmologist and clinical professor of ophthalmology and neurosurgery at the John Wayne Cancer Institute at Providence Saint Johns Health Center in Santa Monica, California.
Preservative-free tears are available over the counter. While theres no single brand or formulation thats ideal for everyone, he says, the more viscous the formula, generally speaking, the more protective and comfortable it will be for your eyes.
One caveat: Thicker artificial tears and lubricating drops can cause a blur, so you may need to try several brands and formulations to find the best one for you. You can also try saving the most viscous gels or ointments for bedtime.
Also Check: Thyroid And Foot Pain
Why A Multidisciplinary Ted Clinic
When people who have TED get care at a multidisciplinary thyroid eye clinic, they have better outcomes than those who go elsewhere.
At UPMC’s clinic, you’ll see both an ophthalmologist and endocrinologist skilled in assessing and treating TED.
Endocrine surgery, ENT, and other specialists are also part of the team and provide consults when needed.
Graves Ophthalmopathy: Common Questions & Answers
How can I check my thyroid at home?
If you want to check your thyroid at home, youll need to have a mirror and glass of water at your disposal. Once you have both, take the mirror and hold it in front of you. Focus on the lower, front zone of the next.
Your thyroid gland will be there, above the collar bone and below the voice box. Tipping your head back while maintaining your focus, drink some water.
Next, look at your neck as you swallow and see if any bulges or protrusions appear in the swallowing area.
Youll want to repeat this process various times, making sure to remember that the gland is closer to the collarbone. If you notice any bulges or protrusions, you should see your healthcare provider for a follow-up confirmation.
Does thyroid eye disease go back to normal?
Thyroid eye disease can resolve within 1-2 years. However, people with this condition may not always restore their normal orbital anatomy . In these cases, skilled orbital surgery is necessary.
Can thyroid eye disease resolve on its own?
Yes, it can. It lasts approximately 1-2 years. However, you should speak with your physician to explore management and treatment options.
Thyroid eye disease is a serious condition that can affect daily life vision dramatically. You may need medications to reduce symptoms and close-up monitoring.
What is the best treatment for Graves disease?
Your doctor may recommend three treatment options, including medications, radioiodine therapy, and thyroid surgery.
You May Like: Can I Take Collagen With Levothyroxine