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What Is Thyroid Eye Disease Symptoms

Dry Eye Or Excessive Tearing

Thyroid Eye Disease- causes, symptoms, diagnosis, treatment, pathology

Inflammation can also lead to a range of eye issues, including dry eye, which can feel as if theyre constantly gritty. Artificial tears can help restore lubrication, says Kossler. Paradoxically, dryness can also cause watery eyes, because the body ramps up tear production to combat the irritation, according to the Mayo Clinic.

What Causes Graves Disease

Researchers arent sure why some people develop autoimmune disorders such as Graves disease. These disorders probably develop from a combination of genes and an outside trigger, such as a virus.

With Graves disease, the immune system makes an antibody called thyroid-stimulating immunoglobulin that attaches to thyroid cells. TSI acts like thyroid-stimulating hormone , a hormone made in the pituitary gland that tells the thyroid how much thyroid hormone to make. TSI causes the thyroid to make too much thyroid hormone.

When To See A Doctor Or Go To The Hospital

If you have symptoms that could indicate thyroid eye disease, you should talk to a doctor as soon as possible. Early diagnosis can lead to faster treatments that may help you avoid some of the potential complications of the disease.

Even if you have already received a thyroid eye disease diagnosis, you should notify your doctor of any changes in symptoms. It is important to keep monitoring your condition, so your doctor can adjust treatments.

In general, you should notify your doctor if you notice any changes in the appearance of your eyes or have problems seeing.

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What Is Thyroid Eye Disease

In thyroid eye disease the muscles and fatty tissues within the eye socket become inflamed and swollen, pushing the eyeball forward and affecting the movements of the eye. This causes bulging eyes . In severe cases vision may be affected. It is usually associated with an overactive thyroid gland – and most often with one particular cause of an overactive thyroid gland, Graves’ disease. See the separate leaflet called Overactive Thyroid Gland .

There is limited space inside the orbit so, as the tissues swell, the eyeball is pushed forwards. Usually this is mild, but in severe cases the eye is pushed far enough forward that the eyelids don’t close as effectively. This leaves the clear window in the front part of the eye dry and unprotected. The eyeball also cannot move so easily, as the muscles that control it work less well. When the disease is very severe, the nerve connecting the eyeball to the brain can be compressed and damaged.

In thyroid eye disease there is an ‘active phase’ – a period of inflammation and swelling – followed by a healing response.

Thyroid eye disease is sometimes called other names such as thyroid ophthalmopathy, dysthyroid eye disease, Graves’ ophthalmopathy or ophthalmic Graves’ disease. However, a significant minority of cases are not associated with Graves’ disease.

Evaluating The Activity And Severity Of Ted

Thyroid Eye Disease: Symptoms, Causes, Diagnosis, and ...

When examining patients with TED, it is important to document both the current activity and severity of disease. This helps both the patient and physician track the course of the disease as well as monitor for signs and symptoms of “flare-ups” or disease recurrence. In addition, management is based on both the activity and severity of disease, making proper disease categorization of great importance in determining proper treatment strategies.

To assess the activity level of TED, the Clinical Activity Score can be used

  • At the initial visit, patients are given a CAS score of 1-7
  • Spontaneous pain in or around the eye in the past 4 weeks
  • Eye pain associated with eye movement in the past 4 weeks
  • Swelling of the eyelids
  • Conjunctival injection
  • Chemosis
  • Swelling of the caruncle

Figure 13 – Clinical Activity Score

Initial Visit

  • spontaneous orbital pain in last 4 weeks
  • Gaze-evoked orbital pain in last 4 weeks
  • Eyelid swelling
  • Inflammation of caruncle or plica semilunaris
  • CAS ⥠3 â “Active”

    Follow-up Visit

    – Criteria 1-7

    CAS ⥠4 â “Active”

    • At subsequent follow-up visits, the 3 following criteria are added for a potential CAS score of 10
    • Increase in proptosis/exophthalmos of the eye
  • TED is considered “active” if the CAS ââ°Â¥ 3 at the initial visit, or ââ°Â¥ 4 at follow-up visits
  • To grade the severity of TED, many indices are used, two of which are mentioned below

  • The European Group of Graves’ Orbitopathy classifies TED severity into three categories
  • Mild
  • Selenium
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    How Can Ted Be Managed During The Active Stage

    During the active stage of TED, treatments are aimed at improving your symptoms and protecting your eyes while the active stage of the condition runs its course. Symptoms can fluctuate during the active stage which can last months or a couple of years.

    Most commonly, during the active stage, treatment involves treating dry eyes or double vision. Symptoms of dry eye can be managed with artificial tear eye drops, and double vision may be managed with prisms or occlusion . For most people, this is all the treatment they will need at this stage and the condition wont get any more advanced than this.

    Much less commonly, where your vision is at risk, your ophthalmologist may recommend immunosuppressant treatment, usually steroids, to help reduce the inflammation. Orbital radiotherapy treatment may also be considered to treat the tissues around the eyeball and prevent optic nerve damage. The earlier these treatments can be given, the more they can help prevent the condition from progressing and protect your sight. In very severe cases, emergency orbital decompression surgery may be needed this operation involves removing some of the bone and/or fat in your eye socket to provide more room for the swollen muscles, and to take the pressure off the optic nerve. All these treatments aim to avoid permanent damage to your optic nerve. Very few people have TED that progresses to a stage where these treatments are needed.

    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.

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    The Eye Specialist Role

    Roger Dailey, M.D., F.A.C.S., specializes in TED and has nearly 30 years of experience in treating patients that develop thyroid related eye problems. His first role may be to help you get through the time when your eyes are changing and provide simple solutions to the irritation, tearing and swelling often associated with TED. Often this involves something as simple as using artificial tears frequently during the day and lubrication ointment at night. In addition, sleeping with your head elevated at night will often help decrease swelling around the eyes. The second role is to help determine when your eyes have stopped changing so that corrective surgery can commence if necessary. A third role is to help you watch for the rare serious problems associated with TED that need prompt treatment. This may involve some degree of vision loss.

    Who Is More Likely To Develop Graves’ Disease

    THYROID EYE DISEASE | Causes, Symptoms, My Story Tips

    Graves disease usually affects people between ages 30 and 50, but can occur at any age.2 The disease is seven to eight times more common in women than men.3 A persons chance of developing Graves disease increases if other family members have the disease.

    People with other autoimmune disorders are more likely to develop Graves disease than people without these disorders. Conditions linked with Graves disease include

    • rheumatoid arthritis, a disorder that affects the joints and sometimes other body systems
    • pernicious anemia, a condition caused by a vitamin B12 deficiency
    • lupus, a chronic, or long-term, disorder that can affect many parts of your body

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    Who Develops Thyroid Eye Disease

    Thyroid eye disease is a rare condition. Each year it affects about 16 women and 3 men in every 100,000 people. Most of these people also have a problem with an overactive thyroid gland and have an underlying autoimmune condition. Occasionally, thyroid eye disease occurs when the thyroid gland appears to be working normally. However, people with an apparently normal thyroid gland at the time of thyroid eye disease have usually had abnormal thyroid function in the past or they go on to develop abnormal thyroid function in the future.

    Thyroid eye disease generally occurs in middle age. Some people carry genes which make it more likely that they will develop thyroid eye disease. It is also more likely to develop if you smoke, particularly if you are a heavy smoker.

    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

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    What Triggers Thyroid Eye Disease

    Thyroid eye disease is most likely to occur within 6 months of a diagnosis of Graves disease. However, TED can occur in Graves patients with normal or even low thyroid levels.

    While it commonly occurs with Graves disease, TED can occur with Hashimotos thyroiditis, a hypothyroid condition. TED isnt directly linked to high thyroid levels.

    Sometimes, TED is the first sign of any thyroid problem. However, higher thyroid levels wont cause a more severe case of thyroid eye disease.

    Autoimmune diseases remain a mystery. Its not clear what causes the body to attack healthy cells.

    Smoking or spending a lot of time with someone who smokes can increase the risk for TED. If you already have TED, smoking can make symptoms worse.

    Thyroid Eye Disease: Symptoms Diagnosis And Treatment

    Thyroid Eye Disease, Presenting symptoms

    Thyroid eye disease is also called Thyroid Orbitopathy is an eye problem that affects the soft tissues of the eye that border or is adjacent to the eyes. the foremost noticeable symptoms include inflammation and swelling of the tissues triggered by an abnormal immune response.

    As the swelling continues, so does the space within the eye and as a result, the eyeball is hard-pressed. The cornea in effect isnt adequately protected by the eyelid. The movement of the attention ball within the eye is restricted because of the reduced functionality of the muscles in the eye.

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    What Are The Symptoms Of Graves Disease

    You may have common symptoms of hyperthyroidism such as

    • fast and irregular heartbeat
    • trouble sleeping
    • weight loss

    Rarely, people with Graves disease develop a reddish thickening of the skin on the shins, a condition called pretibial myxedema or Graves dermopathy. This skin problem is usually painless and mild, but it can be painful for some.

    GO can cause retracted eyelids, meaning the eyelids are pulled back from the eye. GO can also cause bulging eyes, double vision, and swelling around the eyes.

    The Phases Of Thyroid Eye Disease

    There are two phases of thyroid eye disease:

  • The active stage is the period in which progressive inflammation, swelling, and tissue changes occur. These typically last for about six months to two years.
  • The inactive or burnt-out stage is the stable phase when active inflammation settles down and the disease progression stops. In some patients, the eyes return to normal whereas some may have permanent changes .
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    How Can The Long

    In most people, the active inflamed stage of TED resolves within about two years. In a few people, active TED can recur again after it has burnt out, although this becomes less likely the longer that the condition has been inactive.

    Treatment after TED has burnt out is aimed at dealing with any remaining double vision, providing better eyelid protection for your eyes and improving the appearance of your eyes.

    The swelling caused by TED can often improve once the active stage has passed, meaning there can be some improvement in the appearance of your eyes. However, you might be left with some changes caused by the swelling, such as eyelid retraction , exophthalmos , large eyelid bags or double vision. This is because the tissues that have been inflamed are often less flexible once the active phase of the condition has passed, and theyre not able to return to their original position.

    If this is the case, then you may wish to decide whether or not to have further surgery to help improve these changes. Sometimes the problems that are left may only be minor and you may feel treatment is not necessary, or that the risks of the surgery outweigh the problems that you have.

    For more information on how TED affects your sight and the available treatments, .

    The Thyroid Gland And Important Terms

    What is Thyroid Eye Disease?

    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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    What Should You Do If You Think You Have Signs And Symptoms Of A Thyroid Disorder Which Type Of Doctors Treat Thyroid Problems

    • Thyroid disease is a broad spectrum of disorders that may or may not lead to enlargement of the thyroid gland itself or the presence of lumps or nodules.
    • Signs and symptoms of thyroid disease are apparent when the gland is over- or under-producing thyroid hormone.
    • It is important to remember that none of these symptoms described in this article is specific for thyroid disease.
    • A number of different conditions and normal states may cause all of them.
    • Your doctor or endocrinologist can order laboratory tests to evaluate the function of your thyroid gland if you have troubling symptoms.

    Thyroid Eye Disease Symptoms Vary

    TED symptoms can vary, and they may come and go, but Marx lists these as a few of the most common:

    • Eyelid retractionHappens when muscles surrounding the eye swell and push the eye forward, pulling upper and lower eyelids back.
    • Eye protrusionSwelling may push the eye forward and make the patient look like they are staring.
    • Dry eyeWhen the eyes retract or protrude, theyre exposed to dust and wind. This can cause dryness and an uncomfortable, scratchy feeling. It may also cause blurry vision and light sensitivity.
    • Vision changesSwelling around the eye may cause double vision. It can also put pressure on the optic nerve, which connects the eye to the brain.
    • Eye bagsSwelling can cause the tissue around the eye to bulge, commonly called bags around the eyes.

    Fortunately, we can treat all of these symptoms, and some new drugs are helping to make a real difference for some patients. But the treatments can vary as much as the symptoms, says Marx. Because TED diagnoses and symptoms tend toward the complex, patients need to work closely with their ophthalmologists and thyroid specialists to find the best, customized treatments.

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    Treatment For Thyroid Eye Disease

    Treatment for thyroid eye disease involves many different tactics depending on the severity of the condition and when it is discovered. This can include treating dry eye, treating double vision, occlusion and the use of prisms.

    To treat thyroid eye disease the goal is to treat the symptoms as there is no cure. Treatment of thyroid eye disease may include:

    • Liquid tears to combat dry eyes
    • Ointments, eye patches or even tape to close the eyelid if they do not close at night
    • Night time head elevation if swelling occurs in the evening
    • Wearing specific glasses to treat blurry or double vision
    • Steroid or steroid-like medication to combat worsening vision
    • When to see a doctor for thyroid eye disease
    • You should see a doctor for thyroid eye disease if you experience any of the following symptoms:
    • Changes in appearance of the eyes
    • Feeling of grittiness of the eyes
    • Dry or watery eyes
    • Pain in or around the eyes
    • Difficulty moving the eyes

    Because the cause is unknown for thyroid eye disease there are no suggested prevention methods. Ensure as you age that you get your thyroid checked out and treat conditions like hyperthyroid or hypothyroid.

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