Check With Your Healthcare Provider
Some treatments can interfere with medications or cause side effects. Always discuss all your OTC, herbal, vitamin, and mineral supplements with a healthcare provider.
Research indicates that some people who have thyroid eye disease may be deficient in selenium and vitamin D.
Taking supplements with selenium and vitamin D may be helpful, but studies are limited on the effectiveness of this treatment. Selenium supplements may be more useful for people who live in areas with soil that is deficient in this mineral.
Ted Patients Respond To Teprotumumab Treatment
Significantly more patients were classified as responders in the Teprotumumab group than in the placebo group . Furthermore, the average CAS score dropped by 3.4 points and proptosis was down by 2.46 mm in the treated group.
The Graves’ Ophthalmology Quality of Life scores, a secondary outcome, also showed a significant improvement with Teprotumumab treatment, both in the overall score and in the visual functioning subscale.
Details of the Phase 2 results were published by Smith et al. in the New England Journal of Medicine , where they report that Teprotumumab treatment was effective in some patients as early as 6 weeks.
The Phase 3 clinical study supported all results of its predecessor study, with 82.9% of Teprotumumab treated patients falling into the responder category.
What Triggers Thyroid Eye Disease
What are the symptoms that I should be monitoring for to assess for whether the TED is worsening? When do I seek urgent care? What can I do to prevent further worsening of the TED? For patients who also have Graves disease and are considering treatment with radioactive iodine: Based on my risk factors, am I a candidate for prophylactic corticosteroid therapy after radioactive iodine to prevent worsening TED? For patients who have active, progressive TED regardless of their history of prior TED treatment: Based on my current disease state, am I a candidate for teprotumumab?
Editor: Andrea Kossler, M.D., FACS, Palak Choksi, M.D., Brandon Pham, Debbie Chen, M.D. Last Updated: January 24, 2022 Endocrine Society.Thyroid Cancer | Endocrine Society. Endocrine.org, Endocrine Society, 18 January 2022, http://admin.endocrine.org/?sc_mode=edit& sc_itemid=%7bE64BCF38-1719-40E3-85C8-3BA275BFFB54%7d& sc_version=1& sc_lang=en& sc_site=endocrine : Thyroid Eye Disease
How do they treat thyroid eye?
Tests and Diagnosis If your doctor suspects you have an overactive thyroid gland, your thyroid function must first be evaluated and treated appropriately by an internist trained in doing so. Treatments include medications to suppress the production of hormone by the thyroid gland, radioactive iodine to eliminate hormone-producing cells, and surgery to remove the thyroid tissue.
How can I reverse my thyroid eye?
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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.
How To Live With Thyroid Eye Disease
There is no cure for thyroid eye disease. The condition often goes away after a few months, but this is not guaranteed. If it does go away, the damage it has done to your eyes may not return to normal.
Despite this, it is possible to live a happy and fulfilled life with thyroid eye disease. To do this:
- Manage your symptoms. Observe how your condition is affecting your life and ask your doctor for possible treatment options to address problem areas. This will help you maintain a high quality of life even while ill.
- Treat any thyroid conditions you have. Uncontrolled thyroid problems will make thyroid eye disease worse.
- Live a healthy lifestyle. Exercise and a good diet are essential to managing autoimmune disease.
- Avoid stress. Stress is a major factor in the development and progression of autoimmune disease.
- Follow your eye doctors recommended course of treatment and keep in close contact with them. If your conditions worsens, you may need to adjust your course of treatment.
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A Game Changer For Ted Patients
The use of this drug is a game changer for treating TED. For 20 years I have said to my patients, One day there will be a magic bullet for your disease. This drug is just that. It provides results as good, or better, than our surgical treatments, such as orbital decompression. By treating early, we are able to spare these patients years of misery due to the functional limitations and physical appearance changes caused by TED.
Dr. Douglas reports receiving consulting fees from Horizon Therapeutics. Dr. Harrison reports no current conflicts with regard to discussing this study.
Home Remedies And Lifestyle
Your healthcare provider may decide to start the process by carefully watching your symptoms to see if they worsen before prescribing treatments for thyroid eye disease. This is usually done if your symptoms are mild and do not interfere with the quality of your life.
Symptoms can improve on their own. During this time, you may want to discuss home remedies or lifestyle changes.
Lifestyle changes and home remedies may include:
- Quitting smoking
- Putting cool compresses on the eyes to reduce swelling and irritation
- Wearing sunglasses to reduce sensitivity to light
- Wearing glasses with prisms to fix double vision
- Wearing an eyepatch to fix double vision
- Raising the head of your bed to sleep higher and reduce swelling
- Taping eyelids closed at night to prevent dry eyes
- Changing your diet to reduce excess iodine
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.
Monoclonal Antibody Angles To Be 1st Treatment For Ted
Dr. Smith described a novel autoantibody that binds to and may activate a specific receptor that leading to an exaggerated autoimmune response. This work led to the identification of potential therapeutic targets that, when distrupted, may halt progression of the thyroid eye disease process.
It was this pioneering work that was the basis for development of teprotumumab, the first pharmacological therapy to alter the severity of symptom relief for this disfiguring, painful and potentially blinding thyroid-related eye disease.
Until now, orbital decompression surgery has been the only treatment for the 30-50% of individuals with Graves disease that also resulted in thyroid eye disease.³
Now there there is the prospect of treatmentteprotumumab is a fully human monoclonal antibody that functions as an insulin-like growth factor-1 inhibitor acting to interrupt autoimmune activity and the inflammatory response, which offers a favorable risk/benefit profile for Graves’ orbitopathy, Dr. Smith said.
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Study: Breakthrough Drug Reduces Graves Eye Disease Symptoms
A study drug safely minimizes severity for those with a painful eye condition, a new clinical trial at the University of Michigan Kellogg Eye Center has found.
The disease is characterized by inflammation and a buildup of tissue around the eyes that cause them to bulge painfully from their sockets.
There has never been a safe and effective treatment for Graves eye disease, also known as thyroid eye disease , for the 1 million Americans with the condition. Anti-inflammatory medicines offer inconsistent benefits. Orbital decompression surgery helps give some patients a more natural appearance, but only after the disease has run its course.
But 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 symptoms after treatment with teprotumumab, a study drug the Food and Drug Administration designated a breakthrough therapy.
Most patients in the trial who got the active drug instead of a placebo had reduced eye bulging, eye pain and swelling and improved quality of life.
For some, the therapeutic benefit was rapid, occurring within six weeks of intravenous infusions of the drug that blocks what researchers say is an autoimmune attack on the muscles around the eyes.
What Is The Extended Durability Of Teprotumumab
We have some initial insights into the intermediate durability of the therapy in that 48-week data from the clinical study suggests that the majority of responders , remained inactive and showed no progression. This was an additional 24 weeks beyond the therapeutic phase of the trial, Dr. Smith said.
However, there is no information yet on long-term outcomes in patients treated for 24 weeks but certainly this reamins a critical question, said Dr. Smith. Just such a study has already begun recruitment.
Horizon has initiated the OPTICX open label phase 3 extension trial to continue to gather data on the long-term efficacy and safety of teprotumumab in patients who completed the 24-week course of therapy and who met the criteria for relapse. They were eligible to enroll to receive eight additional infusions over a second Graves eye disease the expected study completion is March 2022.8
Teprotumumab product has been designated for priority review given its potential as a significance advance in the here to for lack of therapeutic treatment for thyroid eye disease. The manufacturer has indicated a Prescription Drug User Fee Act goal date of early March 2020.
“Once this drug is available, patients who have moderate to severe thyroid eye disease will be able to receive treatment immediately, which means they will not be required to wait years ,” Dr. Douglas told EndocrineWeb, as has been the circumstance until now.
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What Is The Treatment Of Thyroid Eye Disease
Thyroid eye disease is a rare eye condition characterized by progressive inflammation of and damage to the muscles and soft tissues in and around the eyes, especially the extraocular muscles , connective, and fatty tissue. TED is also known as thyroid-associated ophthalmopathy , thyroid orbitopathy, Graves orbitopathy, or Graves ophthalmopathy . The disease often appears suddenly with endocrine and ophthalmic symptoms impairing normal life. TED can cause facial disfigurement affecting the quality of life and daily function of patients.
Treatment of TED involves medications for controlling the symptoms protecting the eyes maintaining optimal thyroid hormone levels by using oral antithyroid medicine , radioactive iodine, medications to suppress the immune system, and vitamin supplements such as selenium and performing thyroidectomy and surgery to restore the function and appearance of the eyes .
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
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
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What Is The Difference Between Acute And Chronic Thyroid Eye Disease
Thyroid Eye Disease has two phases. The first is called the acute phase, which you may also hear your doctor describe as the active phase. The second is called the chronic phase, which your doctor may call the inactive phase.
In the acute phase, symptoms like eye bulging, pain, redness, and swelling may appear suddenly and often get worse quickly. The length of this phase is different for everyone, but it usually lasts from 6 months to about 2 years.
In the chronic phase, symptoms like redness and swelling may not get worse or could even improve. But TED is an ongoing disease. Some symptoms may slow down, but that does not mean they go away. Its even possible for some symptoms to return or flare up.
Scarring that starts in the acute phase can cause damage and leave you with ongoing symptoms in the chronic phase, like eye pain and pressure, eye bulging, misaligned eyes, and double vision. Thats why its important to get treatment early to avoid further eye damage.
What Are The Signs And Symptoms Of Thyroid Eye Disease
The signs and symptoms of thyroid eye disease include:
- Pain behind your eyes and pain with eye movements.
Symptoms normally affect both eyes, but sometimes you may only notice symptoms in one eye.
Is thyroid eye disease contagious?
No. Thyroid eye disease isnt contagious. You cant catch it from anyone, and you cant transmit it to anyone.
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How Is Thyroid Eye Disease Diagnosed
The characteristic eye signs often make a doctor suspicious that Graves disease is present. Also, blood testing frequently shows abnormal levels of thyroid hormones. Magnetic resonance imaging , computed tomography of the orbits and eyes or ocular ultrasound may also be used to diagnose the disease. These imaging methods can reveal swelling of the eye tissues and muscles in a pattern consistent with thyroid eye disease.
Use And Important Safety Information
What is the most important information I should know about TEPEZZA?
Infusion reactions can happen during or within 24 hours after your infusion of TEPEZZA. If you have a reaction while receiving TEPEZZA, your doctor or nurse will slow or stop your infusion and treat your reaction. If you have a severe infusion reaction, your doctor may stop your treatment completely.
Tell your doctor or nurse right away if you have any of these symptoms during or after your treatment with TEPEZZA:
- High blood pressure
- Redness of the face/Feeling hot
- Difficulty breathing
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What Causes Dry Eye
There are a few ways Thyroid Eye Disease can cause dry eye.
The muscles in the eyelids can tighten, causing the upper and lower lids to pull back. As a result, it may be harder to close the eyes, leaving them more likely to feel dry or irritated. Eye bulging can also prevent eyelids from closing completely. This leaves the clear, protective layer over the front of the eye exposed. See before and after photos of how TEPEZZA treats eye bulging.
During acute TED, tear ducts may become inflamed , which can also cause dryness. Learn more about Thyroid Eye Disease symptoms.
Before Treatment For Ted Can Be Effective Timely Diagnosis Is Needed
Patients typically were told that they must wait several yearsduring the active phase of TEDfor their symptoms to dissapate. However, some damage to vision occuring during this waiting period was irreversible, said Dr. Smith.
Figure 1. Examples of TED Signs and Symptoms
Common signs of thyroid eye disease include bulging of the eyes, redness and swelling, Image: Horizon Pharmaceuticals
To recognize thyroid eye disease, the most common signs are:
Inflammation of orbital soft tissues causing pain, erythema, swelling and foreign object sensation in the eyes
Eyelid retraction with increased eyelid aperture
Proptosis , due to expansion of the soft tissues of the orbit forcing eyes to prortrude from their sockets
Strabismus with compromised eye motility
Diplopia , due to incorrect orientation of the eyes
Corneal ulceration because patients cannot fully close their eyelids
Optic neuropathy arising from rigid orbital walls and tissue enlargement putting undue pressure on the optic nerve
These signs and symptoms often progress, particularly in moderate to severe cases of TED.
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What Is An Autoimmune Disease
Normally, your immune system can tell the difference between healthy cells and foreign cells, like bacteria. An autoimmune disease is a condition where your immune system mistakenly attacks healthy parts of the body. Autoimmune diseases are chronic, or lifelong, conditions. There are more than 80 different autoimmune diseases.
With Thyroid Eye Disease , the immune system attacks the muscle and fat tissue behind your eyes. This causes inflammation and scar tissue to form. This leads to symptoms such as bulging eyes and changes in vision.
How Common Is Thyroid Eye Disease
Disease Thyroid eye disease is an autoimmune disease caused by the activation of orbital fibroblasts by autoantibodies directed against thyroid receptors. TED is a rare disease, which had an incidence rate of approximately 19 in 100,000 people per year in one study.
The disorder characterized by enlargement of the extraocular muscles, fatty and connective tissue volume. Graves disease is an autoimmune disorder involving the thyroid gland, typically characterized by the presence of circulating autoantibodies that bind to and stimulate the thyroid hormone receptor , resulting in hyperthyroidism and goiter.
Organs other than the thyroid can also be affected, leading to the extrathyroidal manifestations of GD. TED is observed in ~ 50% of patients while Graves dermopathy and acropachy are quite rare. TED was previously known as thyroid-associated ophthalmopathy , Graves orbitopathy and other variations.
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