Tuesday, February 27, 2024

Thyroid Eye Disease Bulging Eyes

Ask Your Doctor If You Should Try A Selenium Supplement

WVU Medicine Tuesday Talks: Thyroid Eye Disease

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.

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.

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.

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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.

Thyroid Eye Disease Symptoms

Before and After

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.

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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

Am I At Risk For Graves Eye Disease

If you have Graves disease, youre at risk for Graves eye disease. About 1 in 3 people with Graves disease develop some of these eye problems.

Smoking increases the risk for eye problems in people with Graves disease. If you smoke, make a plan to quit. You can call 1-800-QUIT-NOW for free support or check out the resources on Smokefree.gov.

Graves disease is much more common in women and usually develops before age 40. Youre at higher risk if you have a family history of Graves disease or if you have another autoimmune disease, like rheumatoid arthritis.

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Treatment For Bulging Eyes

Dr. Eftekhari treats many patients who have thyroid eye disease. In the past, weekly steroid infusions or oral steroids were the standard of care. Both of these types of treatments have side effects. For some patients, there is a new medication for thyroid eye disease. In 2020, the FDA approved Tepezza as the first medication approved specifically for thyroid eye disease. Dr. Eftekhari has published research articles on this medication. Depending on your severity, Dr. Eftekhari may prescribe this medication for you.

For patients who do not respond to medical therapy or who have scarring, Dr. Eftekhari performs surgery as in the above photo. Some surgery creates more space in the eye socket for the bulging eye to sit farther back into the eye socket . Other surgery addresses abnormalities of the eyelids . Dr. Eftekhari has extensive experience performing these surgeries. Dr. Eftekhari is board-certified and is a member of the International Thyroid Eye Disease Society and the American Society for Ophthalmic Plastic and Reconstructive Surgery .

If you have thyroid disease and have noticed changes around your eyes, call our office for a consultation.

Bulging Eyes Thyroid At Eyelidpros

Is Bulging Eye Disease Called Thyroid Eye Disease (TED)? Is Graves Disease Caused By TED?

Are you interested in bulging eyes thyroid treatment in St. Clair Shores, MI,Rochester Hills, MI,Dearborn, MI, or the surrounding areas? If so, the board-certified physicians and reconstructive plastic surgeons at EyelidPros can help you. Our staff will make sure the ideal treatments are selected for your specific situation. If you are ready to schedule a consultation or are interested in learning more about us, contact one of our Michigan locations, and a staff member will reply shortly.

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How Is Thyroid Eye Disease Treated / Managed

Thyroid eye disease in its active phase can last between one and three years. That means if it is left untreated, the inflammation may gradually decrease by itself but may cause damage to vision through the course of the disease. Sometimes, the changes caused by the enlargement of the tissues may not go away. The goal of treatment is to limit inflammation and swelling occurring during the active or inflammatory phase and to protect the front of the eye and prevent vision loss.

Thyroid eye disease is managed by a specialist eye doctor . Any underlying thyroid problems will be managed by your primary care doctor or by a specialist in the hormone systems of the body .

If a thyroid issue is suspected, evaluation and treatment are critical. The first priority is to restore your normal thyroid function. In addition, eye conditions should be examined and treated at the same time as your thyroid gland treatment. Eye problems may continue to progress even after your thyroid function returns to normal.

If you have thyroid eye disease, your eye doctor may recommend one or more of the following treatments to help soothe your eyes and improve your vision:

Cool compresses: Apply cool compresses to your eyes. The extra moisture and cooling effect may provide relief.

Sunglasses: When you have thyroid eye disease, your eyes are more sensitive to sunlight and UV rays. Wearing sunglasses helps protect them from both sun and wind.

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.

To learn more, check out the following resources:

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Problems Caused By Bulging Eyes

Your face and eyes are usually the first things others notice about you. When you have a visible symptom like proptosis, this can lead to feelings of insecurity, self-consciousness, and social isolation. Even if you are the only person who notices these changes, they can deeply impact your life.4

Beyond the cosmetic issues, proptosis can lead to physical discomfort and complications, including:1-3

  • Dry eyes When the eye is pushed out of the socket, more of the eyeball is exposed to the air. Plus, it is harder for the eyelids to cover the eyes when blinking. Because blinking is protective and restorative to the eye, problems with blinking can lead to dry eyes.
  • Corneal ulcer An open sore on the front of the eye is known as a corneal ulcer. Impaired blinking and dry eye that occurs in TED increases the risk of this complication.
  • Eye pain and pressure Dry, irritated eyes, along with the physical force of fat swelling behind the eye, leads to eye discomfort.
  • Vision changes and problems with the optic nerve The optic nerve is a communication highway from the eye to your brain. When fat and other tissues swell behind and around the eye, the optic nerve can be affected. This leads to vision problems. While these vision problems are often mild, compression of the optic nerve can lead to vision loss if not promptly treated.

The Eye Specialist Role

Before and After

Your specialist can provide simple solutions to the irritation, tearing and swelling often associated with TED. Often, this involves something as simple as using artificial tears during the day and lubrication ointment at night. Your specialist can determine when your eyes have stopped changing and whether corrective surgery is needed. Your specialist may also watch for the rare serious problems associated with TED that need prompt treatment.

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Typical Course Of Thyroid Eye Disease

In many patients, the signs and symptoms of thyroid eye disease increase and peak over the course of a few months, and then stabilize. This process can take 18 to 24 months to run its course, although there is significant variability. In almost all patients, their eyes may get a little bit better but do not return to their previous state or appearance.

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

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Graves’ Disease Sometimes Affects The Eyes Too

Her thyroid blood testing confirmed what the doctor had suspectedChristine had that causes overactive thyroid function, or hyperthyroidism. Although she was prescribed medication to regulate her thyroid and restore her heart rate to normal, her doctor didnt address the fact that her eyes were red and puffy, and looked like they were protruding out of her eye sockets.

I did not realize that there were things I could do to help my eye symptoms until about three years into the disease, says Christine. Previously, I had been told that the annoying eye changes simply had to run their course. But during that time, things got much worse.

It wasnt until several years later that Christine sought treatment for her eyes. In addition to Graves disease, Christine learned that she also has

Graves ophthalmopathy, known more commonly as thyroid eye disease , which affects women 5 to 6 times more often then in men. Thyroid eye disease is an autoimmune condition arising in about half of those with Graves disease it causes the bodys immune system to attack the area behind the eye, causing the muscles and tissues to swell, causing the bulging appearance.

What Can Cause Double Vision

Bulging Eyes | Thyroid Eye Disease | Natural Balance

Thyroid Eye Disease can cause muscles and fat behind the eye to become swollen. Inflammation and damage to the muscles can cause the eyes to point in different directions and make them hard to move. Your doctor may refer to this as strabismus .

Since the eyes may be pointing in different directions, it is harder for them to focus on a single object at the same time. So 1 object is seen as double.

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Strategies To Manage Symptoms Associated With Ted

There are currently no FDA-approved medications to treat TED, and Graves disease medications do not treat the eye symptoms. Complex and costly surgical interventions are often the only option, and patients must wait until their TED becomes inactive to pursue this option.

These eye symptoms when arising due to Graves disease may last up to three years , and then sometimes lessen or can go away but not always. And for those with recalcitrant TED, there is the risk of blindness. Unfortunately for Christine, her thyroid eye disease did not resolve on its own.

I was just trying to live my life like everyone else, but the symptoms of TED were crazy, she recalls. My eyes were pushed out so much that they were almost out of their sockets. If I was in the locker room, I would never stand in front of the mirror to comb my hair because what I saw was such a shocking contrast compared to what everyone else looked like, and how I used to appear.

This Treatment Has The Potential To Alter The Course Of The Disease Potentially Sparing Patients From Needing Multiple Invasive Surgeries By Providing An Alternative Nonsurgical Treatment Option An Official Said

Teprotumumab, a minimally invasive insulin-like growth factor I blocking antibody, has been shown to enhance symptoms, appearance, and quality of life in patients with thyroid eye disease, according to a study.

The findings of the study were published in the New England Journal of Medicine. The randomized, double-blind, placebo-controlled trial was conducted by the department of surgery at Cedars-Sinai and at other medical centers nationwide.

Thyroid eye disease is a rare and vision-threatening autoimmune condition that causes the muscles and fatty tissues behind the eye to become inflamed and enlarged, leading to bulging of the eyes. In addition to the bulging appearance, patients can experience double vision and light sensitivity. The disease can lead to blindness.

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“The study demonstrates that medical treatment with teprotumumab is effective at reversing the manifestations of disease, providing new hope for patients,” said the study’s principal investigator, Raymond Douglas, MD, PhD, director of the Orbital and Thyroid Eye Disease Program at Cedars-Sinai.

Patients received the drug intravenously once every week for three weeks over a 21-week period. Results showed:

Patients who were administered teprotumumab experienced effective response in two doses or six weeks of administration.

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