Little Known Facts About Thyroid Eye Disease

Thyroid Eye Disease is a complex condition of the eye, which can often lead to loss of sight and can be debilitating as well as disfiguring. In this article, we will learn certain facts about Thyroid Eye Disease, which are often not known widely.

Thyroid Eye Disease – The History

Thyroid Eye Disease is also known as Graves’ Ophthalmopathy, which is a symptom of Graves’ Disease, a condition where thyroid hormone levels are increased and account for 60-80% of cases of Thyrotoxicosis. However, 10% of the individual can have low thyroid hormone levels or are hypothyroid and 5% have normal thyroid function and even then present with Thyroid Eye Disease. The condition was first described by Irish Physician Robert J Graves, and hence the name of the condition.

Mechanism Behind Thyroid Eye Disease

Cytokines (some chemicals secreted by immune cells of the body and affect other types of cells in the body) play a key role in Thyroid Eye Disease. It has been found that in Graves ’ disease, the extra-ocular muscles that control the movement of the eyeball are infiltrated by T-cells of the immune system of the body, which then release cytokines on it. This cytokine activates another type of cell in the extra-ocular muscles known as the fibroblasts. The fibroblasts then synthesize a compound called glycosaminoglycans which has the property of trapping water. Trapping of water leads to swelling of the extra-ocular muscles and often this swelling pushes the eyeballs forward leading to exophthalmos. However, later on in the disease process, due to excessive activity of the fibroblasts, the extra-ocular muscles can undergo irreversible fibrosis, causing restriction of movement of the eyes.

Thyroid Eye Disease Symptoms

Individuals suffering from Thyroid Eye Disease can have the following signs and symptoms:

• Dry and Red Eyes
• Double Vision
• Pain on movement of the eye
• Cosmetic Changes like Bulging Eyes
• Inability to close eyelids properly
• Swelling around the eyes

Below is a Thyroid Eye Disease Photos that was taken before and after treatment:

Can Thyroid Eye Disease Make You Blind?

Although infrequent, Thyroid Eye Disease can lead to abrupt onset blindness, which can occur due to Optic Neuropathy (damage to the nerve carrying the sense of vision) and keratopathy (where the cornea that allows light to enter the eyes is diseased).

How to Treat Thyroid Eye Disease

There are multiple treatment modalities for Thyroid Eye Disease. During active disease, injectable corticosteroids are used. Other medications that showed promising results in clinical trials include cyclosporine, azathioprine, methotrexate, rituximab, and Infliximab.

Supplementation with Selenium in individuals suffering from Graves’ Disease has been found to reduce eye involvements leading to Thyroid Eye Disease and slow down its progression as well in case the eyes have been involved.

Orbital Radiotherapy and Surgical Orbital Decompression can also be used in case the individual does not respond to medications. Apart from this, the underlying hyperthyroidism must also be treated under the supervision of an endocrinologist.

Although Thyroid Eye Disease is often a self-limiting condition and rarely causing blindness, once diagnosed it must be adequately treated in a multidisciplinary approach involving endocrinologists, ophthalmologists, and radiologists to low slow the progress as well as for cosmetic reconstruction if required.