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.
Who Is Affected By Thyroid Eye Disease
Thyroid eye disease is a rare condition, and most people will not develop it in their lifetime. Although the precise prevalence is unknown, its estimated that the condition affects about16 out of every 100,000 people, or 0.16%. The same study found that the condition is more likely to affect women, with 22 out of every 100,000 women affected but only 7 out of every 100,0000 men. At the same time, the condition is known to affect men more severely than women.
The condition affects middle-aged people the most, with the condition most prominent among people aged 35-59. TED occurs most frequently in middle-age women with a personal family history of thyroid disease, but may occur at any age in any sex, Dr. Krauss says. Although all races, ethnicities, and nationalities are affected, there is a higher incidence inBlacks and Asians than in other races.
Additionally, TED is highest among people currently smoking as opposed to former smokers or people who have never smoked, highlighting the important role that smoking plays in the development of the condition.
Why Its Important To Talk With Your Doctor
They are your best source of information about TED. Theyâve treated other people with TED and kept up-to-date on the latest research. They can answer most of your questions about this condition and how to manage it.
They know your history. Your doctor knows your family history, medical conditions, typical test results, risk factors, and other things that can affect your thyroid and eye health. For example, radioactive iodine therapy is a treatment that can help with most Gravesâ symptoms but can worsen TED. If you already have eye problems, your doctor can prescribe a form of treatment that is less likely to affect your eyes.
They can help you manage symptoms. TED can cause one or both of your eyes to be red, swollen, dry, or watery. Your doctor can suggest ways to help with these symptoms. If you have mild symptoms, they might recommend at-home strategies like using a cold compress, wearing sunglasses, or using eyedrops.
They also can prescribe steroids or other treatments. For example, steroids can help with pain, redness, and swelling caused by TED. A new drug called teprotumumab can help with double vision, inflammation around the eye, and eye bulging.
About 1 in 20 people with TED develop severe symptoms. You might not be able to fully close your eyes, develop eye ulcers, or lose your vision. Treatment can help preserve your vision and stop TED from getting worse.
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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.
Eye Problems Associated With Hypothyroidism
Hypothyroidism includes any medical condition that results in abnormally low thyroid hormone levels.Autoimmune disease, insufficient dietary iodine, surgery, inadequate stimulation of the thyroid gland and treatment for certain diseases can lead to hypothyroidism. Eye problems may develop in some people with hypothyroidism. Accurate diagnosis of the underlying cause of decreased thyroid function is an important factor in determining the appropriate therapy for eye problems associated with hypothyroidism.
If you are experiencing serious medical symptoms, seek emergency treatment immediately.
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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.
Thyroid Eye Disease Symptoms
TED causes inflammation of the eye tissues that can be uncomfortable, painful, and distressing. Vision changes are also common. Both eyes are usually affected, though you may only experience symptoms in one eye. Although symptoms vary from one individual to another, some of the mostcommon symptoms of TED are:
- A gritty feeling in the eye
- Trouble fully closing your eyes
When you have an active case of TED, not only do you experience swelling around the eyes, but your eyeballs may look like they are bulging, a condition called proptosis.
As patients experience fat and connective tissue enlargement, they may get proptosis, which is bulging of the eyes, where the eyes appear to pop out of the eye sockets, Dr. Boparai explains. Individuals may also experience eyelid retraction and lid lag.
TED may also cause dry eyes, Dr. Boparai says, because of overexposure of the cornea and conjunctiva, the membrane that covers the inside of the eye and inner eyelids. The common symptoms of dry eyes include eye dryness, watery eyes, irritation, burning, and redness, he says. In severe cases, corneal ulcers are possible. Changes in the eye, such as enlargement of the eye muscles and eye movement malfunction may cause diplopia, or double vision, according to Dr. Boparai.
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Can Levothyroxine Cause Dry Eye
Levothyroxine is a medication thats often prescribed to treat hypothyroidism. Common side effects include:
- trouble sleeping
Some people also report eye pain, but this is rare.
Dry eye isnt a reported side effect of levothyroxine. However, if you notice dry eye while taking levothyroxine, its a good idea to mention it to your doctor or a healthcare professional.
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What To Expect At Your Appointment
At your appointment, your doctor might ask about your family and personal medical history. Youâll probably have an eye exam. You also might need a blood test that checks your levels of thyroid hormone or immune markers for Gravesâ disease. Some doctors might run imaging tests like an ultrasound, CT scan, or MRI.
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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.
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.
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Causes Of Thyroid Eye Disease
Doctors do not fully understand what causes TED. Some patients may have a genetic predisposition to developing it. That doesn’t mean they will develop the disease, but they may if the gene gets triggered by other factors.
Several factors are linked with a higher risk of developing TED:
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Certain health conditions Patients with conditions such as Graves disease, type 1 diabetes or rheumatoid arthritis may be more likely to develop TED.
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Family history Patients who have a family member with TED or another autoimmune disease may be more likely to develop it.
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Smoking Patients who smoke have a higher risk of developing this disease than non-smokers.
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Radioactive iodine therapy This common treatment for hyperthyroidism increases the risk of developing TED.
Women also are more likely than men to be diagnosed with thyroid eye disease, and they make up 86% of all cases, according to the American Academy of Ophthalmology . TED occurs most commonly in middle-aged women.
As reported in the Review of Ophthalmology, about 80% of patients who develop the condition have an overactive thyroid that produces too much thyroid hormone, such as with Graves disease. But about 10% of patients have an underactive thyroid that produces too little thyroid hormone. And up to 10% of patients may have normal thyroid function and no diagnosed thyroid disease.
How Can The Thyroid Gland Affect The Eyes
Thyroid disorders, either with elevated hormone level or a depressed hormone level , can affect the eyes. Statistically an under active thyroid gland is more common, which may contribute to increase tired, worn-out appearance and wrinkles.
For some thyroid patients, especially with hyperthyroidism, under eye bags are increased. In advanced cases, the eyes may appear to bulge out of their head.
Most plastic surgeons performing eyelid surgery will evaluate for thyroid condition, in conjunction with the patients primary physician, prior to any facial cosmetic surgery. It is very difficult to determine, however, how much of ones appearance is specifically due to thyroid condition vs. normal aging vs. genetics, or other factors.
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Symptoms Of Thyroid Eye Disease
Early symptoms of thyroid eye disease may include:
- Itching, dry eyes, and difficulty wearing contact lenses
- Excessively watery eyes
- Red or bloodshot eyes
- Swelling of the orbital tissues which causes the eye to be pushed forward referred to as exophthalmos, which can make people with thyroid eye disease appear to have a wide-eyed or bulging, protuberant stare.
- Pain when moving the eyes up, down, or sideways
- Light sensitivity
Thyroid eye disease can cause inflammation and swelling that may affect the eyes as well as the muscles and other tissues around the eyes. As the disease progresses, symptoms can include the following:
- Increased sensitivity to light
- Impaired vision
- Difficulty moving or closing the eyes
Thyroid eye disease is known to go through varying degrees of severity and can go into periods of remission. It often lasts six months to two years. When it has been inactive for a period of around a half a year, it’s less likely to recur.
When To See A Doctor
See your doctor if you have swelling around your eyes that doesnt go away after 24 to 48 hours.
A mild eye infection can go away on its own. Its important to have it checked in case its more serious. An infection can cause complications in your eye if left untreated.
Get immediate medical attention if you have symptoms of an eye infection or other health condition. These include:
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How Is Thyroid Eye Disease Diagnosed
Thyroid eye disease is often diagnosed at the same time as Graves disease. The signs and symptoms described above such as red, swollen eyes will prompt the doctor to suspect thyroid eye disease. A simple blood test called thyroid function test will be carried out to measure the levels of thyroid hormones and thyroid stimulating hormone in the bloodstream. In Graves disease, levels of thyroxine and/or triiodothyronine will usually be raised with undetectable levels of thyroid stimulating hormone. Blood tests may also be carried out to detect thyroid antibodies, which would indicate autoimmune thyroid disease.
If the signs and symptoms are doubtful , a computerised tomography or magnetic resonance imaging scan of the eyes may be used to examine any swelling of the tissues behind the eye.
Who Gets Thyroid Eye Disease
People with Graves’ disease are at higher risk for developing thyroid eye disease. By some estimates, up to 50% of people with Graves’ disease also have symptoms associated with thyroid eye disease.
The condition, however, is sometimes seen in people with no other evidence of thyroid dysfunction, and occasionally in patients who have Hashimoto’s disease. Most thyroid patients, however, will not develop thyroid eye disease, and if so, only mildly. Smoking is associated with a worsening of symptoms.
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Can Thyroid Issues Cause Eye Problems
The thyroid is a small butterfly-shaped gland located at the base of your neck. This endocrine gland is responsible for regulating your body’s energy use. It works with other glands and systems of the body to help determine what the body needs. For example, if you are cold or hot, this gland creates hormones that travel to the body’s cells to help regulate your body temperature. When you have issues with your thyroid, whether it is overactive or underactive , it can affect your body in different ways. As the thyroid gland regulates cellular metabolism in all the cells of your body, virtually every body system is affected when there is an issue with thyroid function.
How your thyroid and any problems it may have affects your vision is dependent on your diagnosis. Understanding your thyroid health and how it can affect your eyes and vision is the first step to ensuring your eye health remains intact while managing your thyroid condition.
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Overview Of The Connection Between Thyroid And Eyes
The thyroid is a small, butterfly-shaped gland at the base of your neck. As part of the endocrine system, the thyroid gland produces hormones that regulate your bodys energy use, along with many other important functions. When thyroid hormone levels are unbalanced, body processes change, affecting virtually every system in the body.
Researchers dont quite understand why thyroid disease can affect your eyes. However, since there are thyroid hormone receptors all over our bodies, it stands to reason that thyroid diseases can affect every organ system.
Common eye complaints in hyperthyroidism
Hyperthyroidism is a condition in which the thyroid gland produces too much thyroid hormone. Signs and symptoms vary from person to person but commonly include irritability, sleeping problems, muscle weakness, fast heartbeat, heat intolerance, tremors, or weight loss. Graves disease, an autoimmune condition, causes more than half of the cases of hyperthyroidism in the United States.
People with hyperthyroidism can have a variety of concerning eye symptoms, including:
One of the hallmark signs of Graves ophthalmopathy is bulging eyes. Not everyone with Graves disease will develop this symptom . Still, vision changes can be hard to restore even with treatment.
Common eye complaints in hypothyroidism
Common eye complaints in people with Hashimotos include:
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How To Manage Your Eye Health
Scheduling annual eye exams to monitor your vision is always recommended, regardless of your thyroid. While you may experience things like blurry or double vision with hyperthyroidism, it is essential to check with your ophthalmologist to find the root cause of any vision issues you may have. If you find yourself squinting or getting chronic headaches, you could very easily need a new prescription. Addressing your vision troubles is nothing to stress about, though. Buying prescription glasses and frames online can be done in minutes. Like many other parts of your body, your eyes can change over time, and without corrective surgery, a stronger prescription will be necessary.