When Should You See A Doctor
You should see your eye doctor immediately if you notice that one or both of your eyes are protruding. While your condition may not be cause for concern, you do not want to leave exophthalmos untreated. If left untreated, exophthalmos can lead to severe cases that may cause permanent vision damage like double vision or vision loss.5
What Is The Prognosis For Patients With Thyroid Eye Disease
The prognosis for patients with Thyroid Eye Disease is quite variable. Some patients have a very mild course and do not require treatments other than eye lubrication. Other patients have eye misalignment causing double vision, and may ultimately require eye surgery. A minority of patients have an extremely severe form of this disease that can cause loss of vision, and they require urgent treatment with medications, radiation treatment, and/or surgery.
How Is Graves’ Disease Treated
Doctors usually treat Graves’ disease with anti-thyroid medicines. These medicines slow the release of thyroid hormones from the gland. They usually bring hormone levels down to normal within a couple of months.
Many people with Graves’ disease need to take anti-thyroid medicines for a long time to control the condition sometimes for the rest of their lives.
Some might need other treatment if anti-thyroid medicines don’t help or cause side effects, or if the disease is very hard to control. In these cases, two permanent treatment options can be used: radioactive iodine treatment and surgery.
Radioactive iodine is the most commonly used permanent treatment for Graves’ disease. RAI damages the thyroid gland so that it can’t make too much thyroid hormone. This doesn’t harm other parts of the body. The RAI treatment is taken in capsules or mixed with a glass of water. The thyroid gland quickly absorbs the RAI from the bloodstream and, within a few months, the gland shrinks and symptoms slowly disappear.
Surgery to remove most of the thyroid gland is called a thyroidectomy. It’s done in a hospital under general anesthesia, so the person is asleep and feels nothing. A small incision in the lower central part of the neck usually leaves a thin scar. It’s common to have some pain for a few days after the surgery, but most people feel much better within a few days.
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What Else Should I Know
We don’t know why people develop Graves’ disease. But with good medical help, kids and teens can be healthy and do all the things other kids and teens can do.
Graves’ eye disease can develop at any time in someone who has Graves’ disease. Smoke can make this eye disease much worse, so it’s very important to not smoke and to avoid secondhand smoke.
Women with Graves’ disease need to be very careful to keep their hormone levels in balance. Uncontrolled thyroid hormone levels in a pregnant woman can lead to problems during pregnancy and harm her baby.
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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How Is Graves’ Disease Diagnosed
Graves’ disease is diagnosed based on a visit with a doctor who will review the symptoms and examine the patient.
It’s important to do lab tests too, because many people can have some of the symptoms of hyperthyroidism for other reasons. Sometimes the blood tests aren’t enough to be sure of the diagnosis and other tests are needed, like a thyroid scan or ultrasound.
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.
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Is There Anything I Can Do
Yes. Here are a few tips:
- We know that one thing that makes this disease worse is smoking. If you smoke, see your GP about getting help to stop. Stopping smoking, even if you already have thyroid eye disease, will reduce the severity.
- Sleeping propped up will help reduce the puffiness around the eyes.
- You may find bright light uncomfortable. Sunglasses will help.
- If you are a driver and experience double vision, let the DVLA know. This is a legal requirement. Usually, they will contact your specialist eye doctor for a report. If the double vision is well controlled with prisms, you may be declared fit to drive. Until then you should not drive.
Thyroid Disease Related Inflammation
In the course of both hyperthyroidism and hypothyroidism, the thyroid disease can lead to inflammation throughout the body.
This inflammation is caused by an error in the hormone based signaling system. When the thyroid hormone levels are not balanced, it can lead to other hormonal issues.
This inflammation can affect the eyes and cause many of the classic signs and symptoms of thyroid eye disease.
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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.
What Should I Do If I Think I Have Ted
Plenty of people chalk up their eye issues to aging or allergies, Douglas says. And even when they try to find out whatâs wrong, they may be told itâs just allergies. If you notice your eyes bulging, vision changes, or your eyelids arenât closing all the way, Douglas advises seeing your doctor. âDonât just settle for an unsatisfactory answer,â he says.
Nasr makes a point of asking all his patients who have autoimmune thyroid disease if their eyes are dry, uncomfortable, or if they have pain behind them. âDry eyes are probably the most common symptom in patients who have thyroid eye disease,â he says. But since dryness can be subtle, it can go unnoticed.
If you already have thyroid disease, you should be seeing an endocrinologist anyway. They will continue doing what they do best — keeping your thyroid well-controlled. Nasr does a thorough eye exam every year. He uses a special instrument to measure how much the eyeball is protruding. Your endocrinologist can refer you to another expert for treatment if needed, too.
Maybe you donât have a history of thyroid disease. In this case, your best option is to see an ophthalmologist. They will be able to diagnose TED. Youâll also need to have your thyroid levels checked by your primary doctor or an endocrinologist. This is because chances are high that you also have undiagnosed Gravesâ disease.
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How Is Thyroid Eye Disease Treated
Your provider will begin by treating you for thyroid disease if you have it. Treating thyroid diseases doesnt treat thyroid eye disease, so your provider may suggest one or more of these therapies:
Over-the-counter medications to treat TED
Eye drops to relieve dryness and irritation are generally non-prescription. You can buy them over the counter. You should use the drops that lubricate but avoid those that take away redness.
Your provider may also suggest selenium supplements if your blood levels of this mineral are low.
A few studies have shown that drinking aloe vera juice reduced inflammation levels in some cases.
Prescription medications to treat TED
Your provider may prescribe anti-inflammatory drugs like prednisone and other systemic steroids and/or rituximab. Discuss the side effects of these treatments with your provider.
Theres also a new medicine available only for thyroid eye disease called teprotumumab .
Lifestyle changes and home remedies to treat TED
The most important lifestyle change you can make is to quit smoking if you smoke. It raises your risk of developing TED by seven to eight times and makes TEDs active disease phase longer. In addition, smoking decreases the effectiveness of treatment for thyroid eye disease. Other things you can do to be more comfortable include:
Surgery to treat TED
Radiation to treat TED
Your provider may suggest radiation therapy to treat the inflammation of thyroid eye disease.
Webmd: Eyes Bulging Not Feeling Quite Right It Could Be Thyroid Eye Disease
WebMD recently interviewed surgeon Raymond Douglas, MD, PhD, professor of Surgery and director of the Thyroid Eye Disease Program at Cedars-Sinai, about the signs of thyroid eye disease and how to treat it.
Thyroid eye disease is a rare autoimmune condition that causes swelling, inflammation, and damage in the muscles and tissues around the eyes.
Symptoms can include redness, dryness, discomfort, irritation or pain behind the eyes as well as eyelid retraction or bulging eyes. Fortunately, “the majority of cases are mild,” Douglas told WebMD.
The condition often affects people who also have Graves’ disease, which causes the body to make too much thyroid hormone. About 80% of patients with thyroid eye disease have already been diagnosed with Graves’, but some people with the disease dont have a thyroid condition at all, according to Douglas.
People often blame aging or allergies for their eye issues, and their symptoms might be dismissed by their provider as mild allergies, Douglas said. But if patients notice their eyes bulging, or if they experience vision changes or eyelids that won’t close completely, Douglas advised seeing a doctor. “Dont settle for an unsatisfactory answer,” he told WebMD.
Click here to read the complete article from WebMD.
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Thyroid Eye Disease Symptoms
When thyroid disease begins to affect the eyes and has symptoms related to the eyes, it can be called thyroid eye disease.
These symptoms are generally related to the inflammation caused by thyroid disease.
The tear glands and tear ducts, the eyelids, and the eye muscles can become red and inflamed in thyroid eye disease.
If the eye muscles and the fatty tissue behind the eye become inflamed, it can lead to the bulging eye appearance that is associated with thyroid eye disease.
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.
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What Is Thyroid Eye Disease
Thyroid eye disease is an eye disorder that causes inflammation and damage to the tissues around the eye, including muscles, fatty tissue and connective tissue. TED is an autoimmune condition, or one that happens because your protective immune system attacks your body.
There are two phases of TED: the active or inflammatory phase and the stable phase. The active phase can last for months up to three years, while the stable phase follows when the inflammation stops.
TED is often related to Graves disease, which is also an autoimmune disease. It can affect the thyroid, eyes and skin.
Graves disease can cause hyperthyroidism, which means that your body releases too many thyroid hormones. Less commonly, Graves disease can also cause hypothyroidism, which means that your body doesnt release enough hormones. Both can result in thyroid eye disease, but people with low levels of thyroid hormone who do have eye swelling and eyebrow hair loss tend to have severe cases of hypothyroidism.
However, thyroid eye disease can happen in people with normal levels of thyroid hormones. Thyroid conditions can also cause secondary glaucoma because of the damage to the optic nerve.
Who does thyroid eye disease affect?
The median age for being diagnosed with TED is 43 years old. However, you can be diagnosed much earlier or much later than 43.
You may be more likely to develop thyroid eye disease if you:
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.
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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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Thyroid eye disease has two general phases an active or progressive phase and a stable or chronic phase. In the active / progressive phase there is ongoing inflammation and change. Patients may notice that their symptoms fluctuate, and they may notice changes in the appearance of their eyes. The active phase lasts on average from 6 months to 2 years.
Once patients enter the chronic / stable phase of the disease, their symptoms are usually stable and dont change quickly. For example, if a patient has eye bulging or eyelid retraction, this will likely not change once the stable phase has been reached, though its important to note that these symptoms do not typically reverse in the stable phase. Doctors will typically wait, if possible, to do surgery during the stable phase. This is because the predictability of surgical outcomes can be better predicted during the stable phase. Rarely, patients may experience re-activation of their thyroid eye disease months or years after entering the stable phase.
If you think you have thyroid eye disease, make an appointment to see an ophthalmologist or an oculoplastic surgeon as soon as possible.
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What Is Hyperthyroidism
Thyroid hormone problems happen when the thyroid gland makes either too much or not enough thyroid hormone.
If the thyroid is overactive, it releases too much thyroid hormone into the bloodstream, causing hyperthyroidism. The body use up energy more quickly than it should, and chemical activity in the cells speeds up.
If the thyroid is underactive, it makes too little thyroid hormone, causing hypothyroidism. The body uses up energy more slowly, and chemical activity in the cells slows down.
Causes Of Bulging Eyes
A common cause of bulging eyes is an overactive thyroid gland .
This is where the thyroid gland , produces too much of the thyroid hormones.
Less common causes of bulging eyes include:
- an infection or injury around or behind your eyes
- bleeding behind the eyes or problems with blood vessels behind the eyes
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