How Is Thyroid Eye Disease Diagnosed
To diagnose thyroid eye disease, you will need a complete eye exam, lab tests, and imaging tests. The ophthalmologist will test your vision, color vision, and visual fields. In addition, eyelid measurements will be taken, eye pressure tested, and optic nerve checked. An exophthalmometer will be used to measure the degree of eye bulging and if and how far forward your eyes have moved due to TED.
If you have not already had a diagnosis of Graves Disease, the doctor may order laboratory tests to confirm whether you do or not have Graves. However, you may not need these tests if you already know that you have Graves Disease.
You will need blood tests to check the levels of thyroid-stimulating hormone , Thyroxine , Triiodothyronine , Thyroid-stimulating immunoglobulin , Thyroid-stimulating hormone receptor antibody , and anti-thyroid peroxidase antibody .
If you do not have a previous diagnosis of Graves Disease, you may have the following imaging tests:
- Radioactive iodine uptake test with X-rays to check how the thyroid collects iodine
- Ultrasound of the thyroid to see if it is enlarged or has nodules
- CT scan to check for an enlarged thyroid and nodules
- MRI to check for an enlarged thyroid and nodules
If you already know that you have Graves disease, a CT scan and MRI will be taken to check the condition of your eyes and eye muscles. These imaging tests can show inflamed tissues, enlarged muscles, and compressed optic nerves in the eyes.
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Fact: Thyroid Conditions And Ted Need To Be Treated By Different Doctors You Should See An Endocrinologist For Graves Disease Or Other Thyroid Conditions And A Ted Specialist For Ted
Graves disease and Thyroid Eye Disease affect different parts of the body. Graves disease affects the thyroid and should be managed by an endocrinologist, who is an expert in treating thyroid issues.
TED is a separate disease that affects the eyes and should be managed by a doctor experienced in treating it: a TED Specialist. There are a few different types of eye doctors who can be TED Specialists.
If you have both conditions, your endocrinologist and your TED Specialist should stay in regular contact with each other. They need to work together to make the best treatment plan for you.
If you suspect you may have Thyroid Eye Disease, see a TED Specialist and ask for a baseline eye exam.
Whats The Treatment For Graves Eye Disease
If you have Graves disease, youll need treatment for your thyroid problems. Sometimes thyroid treatments help with Graves eye disease but people often need separate treatments for their eye problems.
Over-the-counter eye drops. The most common treatment for dry or irritated eyes is a type of eye drops called artificial tears. You can get these without a prescription. There are also over-the-counter gels and ointments that may help your eyes feel better.
Prescription medicines. If you have a lot of swelling behind your eyes, your doctor may prescribe steroids or other medicines to help reduce swelling. Your doctor may also recommend a new medicine just for Graves eye disease called Tepezza .
Quitting smoking. Smoking makes Graves eye disease worse so quitting smoking is the most important lifestyle change you can make if you have this disease.If you smoke, make a plan to quit.
Other lifestyle changes. You can take steps to ease some common symptoms of Graves eye disease.
- If your eyes are sensitive to light, try using over-the-counter eye drops and wearing sunglasses when you go outside
- If you have puffy eyelids, try raising the head of your bed so your head is higher than your body while you sleep
- If your eyelids dont close all the way, try taping them shut at night to prevent dry eye
Eyeglasses. If you have double vision, special prescription lenses can help fix double vision and help you see more clearly.
May 19, 2022
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What Are The Symptoms Of Thyroid Eye Disease
If you have Graves disease, eye symptoms most often begin within six months of disease diagnosis. Very rarely, eye problems may develop long after the Graves disease has been treated. In some patients with eye symptoms, hyperthyroidism never develops and, rarely, patients may have hypothyroidism. The severity of the eye symptoms is not related to the severity of the hyperthyroidism.
Symptoms of thyroid eye disease are caused by the tissues, fat, and muscles of the eye socket swelling and pushing the eyeball forward. It may be possible that symptoms may appear in one eye more than the other. The symptoms of thyroid eye disease include:
Dry, gritty and irritated eyes
Red eyes
Bulging eyes and lid retraction giving a staring or startled appearance
In more advanced thyroid eye disease, there may also be:
- Trouble moving eyes and closing eyes
- Inability to completely close your eye causing a corneal ulcer
- Colors appear to be dull or not as bright
- Blurred or loss of vision due to optic nerve compression or corneal damage
Double vision
How Ted Affects The Eyes
The most common way TED affects the eyes is inflammation and dry eye. TED can cause symptoms of eye watering, grittiness, and pain. Bright lights may be painful or increase your discomfort. Other ways TED affects your eyes include:8
Symptoms of TED can be difficult to cope with. What might seem mild or minor to others can be disrupting and problematic for you.
Talk to your doctor about your symptoms and how TED affects your eyes. The impact of these symptoms on daily life varies, and your doctor needs to know in order to get you the treatment you need and deserve.
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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
How Can Thyroid Affect My Eyes
The most common way TED affects the eyes is by causing symptoms of dry eye – watering, grittiness, and soreness. You may also find that bright lights are uncomfortable.
TED can also cause some changes to the appearance of your eyes, and in some cases, to your vision:
- Your eyelids can become puffy and red , which is often more obvious in the morning
- Your upper eyelid can rise to a higher position than normal, known as eyelid retraction. This can make more of the white of your eye visible, giving a “staring” appearance
- The soft tissues behind your eyeball can swell, pushing your eyes forward so that they “bulge”
- Your orbits may become painful, particularly when your eyes move
- The muscles that move the eyeball can become swollen which can cause double vision
- If the pressure inside your eye sockets increases, it can squash the optic nerve, which can cause blurring or dimming of your vision. Very few people with TED experience this, but it’s important to get medical attention straight away if you notice these changes to your vision
Most people only get a mild form of TED. You may have dry eye which can be managed easily with lubricating eye drops. You may have some eyelid retraction or bulging eyes and any double vision you have may come and go and not cause too much difficulty.
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Who Is At Risk For Thyroid Eye Disease
Thyroid eye disease is most commonly associated with Graves disease. It can also occur with normal thyroid hormone levels or low levels of thyroid hormones .
Other risk factors for thyroid eye disease include:
- Age: Usually affects middle-age adults but can occur at any age
- Gender: Females are affected more than males
- Family history of thyroid eye disease
- Smoking: Smoking increases the risk of thyroid eye disease by 78 times, causes thyroid eye disease to have a longer active phase, and it reduces the effectiveness of treatments
- Radioactive iodine therapy: Radioactive iodine has been used to treat hyperthyroidism and Graves disease. This treatment should be used with caution in people with active thyroid eye disease as it may worsen the condition unless steroids are given at the same time
- Low blood levels of selenium, a dietary mineral.
How Can I Find Support
Because thyroid eye disease can change your vision and appearance, it can have a big effect on your life. It’s important to get support along with your treatment. You might start by talking to family and friends about what youâre going through.
Depression is common in people with thyroid eye disease. If you feel like youâre struggling, talk to your doctor. They can put you in touch with a mental health professional who can help.
Graves’ disease support groups are another place to turn. You’ll meet other people with thyroid eye disease who may have advice to help you manage your condition. You can find a support group through an organization like the Graves’ Disease & Thyroid Foundation.
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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.
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.
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What Should I Ask My Doctor
When you see your doctor for follow-up visits, it’s helpful to have a list of questions ready. You can also bring along a family member or friend to help you remember your questions and write down your doctor’s answers.
Questions can include:
- What follow-up tests will I need to monitor my eyes?
- Who will I need to see for follow-up care?
- What types of treatments do you recommend?
- What kinds of side effects can they cause?
- How might thyroid eye disease affect my daily life?
- Should I call you when I have certain symptoms?
- What type of support is available for thyroid eye disease?
How Is Thyroid Eye Disease Treated
Your primary care doctor or a specialist called an endocrinologist will help you manage thyroid eye disease and get your hormone levels into a normal range. An eye doctor treats symptoms of thyroid eye disease. The goal of treatment is to bring down swelling and protect your eyes.
Your doctor might recommend:
Prism glasses. You get double vision when light lands in the wrong part of your retina. Prism glasses bend light as it goes through your eye so that it lands in the right place. Wearing an eye patch is another way to treat double vision.
Tepezza. Teprotumumab-trbw is the first drug approved to treat thyroid eye disease. It comes as an IV that your doctor gives you every 3 weeks. Tepezza blocks antibodies that attack tissues behind the eye and helps reduce eye bulging, double vision, and other symptoms. The most common side effects are:
- High blood sugar
Steroids. Prednisone and other steroids help bring down swelling in your eyes and treat double vision. Doctors usually prescribe these drugs for only a short time because they can have side effects like fluid buildup, high blood pressure, mood swings, and weight gain.
Radiation. This treatment, which uses beams of intense energy, reduces swelling and relieves double vision. But you can get radiation to your eyes only twice in your life, and it may have side effects like dry eyes. Radiation treatment might also slightly raise your risk for cancer.
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What Causes Graves Eye Disease
Sometimes Graves disease makes the immune system attack the muscles and other tissues around the eyes. This causes swelling behind the eye sockets, which makes the eyes bulge out.
Researchers arent sure what causes Graves disease. They think people with certain genes may be more likely to get it. Viruses or something else in the environment may act as a trigger that makes the disease develop in people who have these genes.
Graves disease isnt contagious you cant get it from or give it to other people.
Vision Issues Associated With Hypothyroidism
Hypothyroidism itself doesn’t specifically target your eyes or vision, but the diseases that cause hypothyroidism can affect your eyes. Hashimoto’s thyroiditis is an autoimmune thyroid disorder in which your immune system attacks the thyroid gland. This autoimmune disorder often leads to hypothyroidism.
Those who suffer from Hashimoto’s can endure eye or vision problems such as dry eyes, blurry vision, and loss of eyelashes or eyebrows. One study finds that those with Hashimoto’s are more likely to have dry eyes than those with healthy thyroid function. This may be because the tear duct of the eye is a target organ of thyroid hormones. Thyroid deficiency may predispose people with hypothyroidism to dry eyes and eye surface changes.
Monitoring your eye health when diagnosed with Hashimoto’s or hypothyroidism will allow you and your thyroid doctor to manage your treatment plan and tackle any symptoms that arise.
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Thyroid Glands Relation To The Eye
Although Graves’ disease and Graves’ eye disease both stem from the immune systems attack on healthy tissue, one disease does not directly cause the other. Thats why treatment of the thyroid gland, while important, does not improve the eye disease. The two diseases run their separate courses and do not necessarily occur at the same time.
How Does Thyroid Eye Disease Affect The Eyes
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The way that thyroid eye disease affects the eyes varies from person to person. Some people will have mild symptoms, while others have severe impacts on their eyes and vision. Early diagnosis and getting the right care are key to reducing the risk for severe complications from TED.1
TED is a rare autoimmune disease. Autoimmune disease results from the bodys immune system mistaking healthy cells and tissue from harmful invaders like viruses, fungi, or bacteria. Because it cannot tell the difference, the immune system attacks and damages healthy cells.1,2
Antibodies are proteins your body makes to kill germs. In TED, harmful antibodies attack various parts of the body, including the tissues around the eyes. This results in inflammation and damage to the muscles, connective tissues, and fat behind and around the eyes. Damage and inflammation get worse over time , with an active and inactive phase.1,3
Knowing how TED affects your eyes can give you a better understanding of the disease.
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What Causes Graves Ophthalmopathy
The exact cause of GO isnt clear, but it may be a combination of genetic and environmental factors.
The inflammation around the eye is due to an autoimmune response. With GO, the same abnormal immune response that triggers the thyroid gland in Graves disease affects the muscles and soft tissues around the eye. This leads your body to produce an inflammatory response.
Symptoms develop because of swelling around the eye, forward bulging of the eyes, and retraction of the eyelids.
Graves eye disease usually occurs in conjunction with hyperthyroidism, but not always. It can occur even when your thyroid isnt currently overactive.
Risk factors for GO include:
- genetic influences
- iodine therapy for hyperthyroidism
Women are also at a higher risk of developing GO compared with men.
Theres no way to completely prevent Graves disease or Graves eye disease. But if you have Graves disease and you smoke, youre around 5 times more likely to develop eye disease than people who dont smoke. Plus, eye disease tends to be more severe for those who smoke.