What to Know About Thyroid Eye Disease (Graves’ Ophthalmopathy)

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Inflammation in the eye tissues can trigger problems such as vision loss and proptosis (eye bulging). If you’ve recently been diagnosed with Graves’ disease — an autoimmune disease that leads to hyperthyroidism, or an overactive thyroid gland — you may also develop a condition called thyroid eye disease.

Thyroid eye disease, also known as Graves’ ophthalmopathy, affects an estimated 1 in every 6,250 women and 1 in 34,482 men, according to the National Organization for Rare Disorders (NORD).

Eye symptoms usually begin within six months of the appearance of Graves’ disease, according to the American Thyroid Association (ATA). Problems can also develop much later, but that’s rare.

Here’s what to know about this eye condition.

What Is Thyroid Eye Disease?

Thyroid eye disease is caused by inflammation in the tissues surrounding the eyes, according to NORD, typically in people who have Graves’ disease.

Graves’ disease occurs when the body mounts an attack against itself. Antibodies begin attacking the thyroid — the butterfly-shaped gland at the base of the neck — and sometimes the cells behind the eyes, which can eventually lead to thyroid eye disease, according to the ATA.

As antibodies attack cells on your eyes called orbital fibroblasts, they release inflammatory substances called cytokines, explains Andrea Kossler, MD, FACS, an assistant professor of ophthalmology at the Stanford University Medical Center in Palo Alto, California, and a thyroid eye disease specialist. “This causes pain, swelling, and redness in the eyes,” she says.

Experts believe these orbital fibroblasts essentially grow into fat or muscle cells. As a result, the body produces additional fat behind and around the eye, which pushes the eye forward, causing eye bulging. The muscles that control eye movement can also enlarge, causing double vision, Dr. Kossler explains.

As thyroid eye disease advances, this process can eventually compress the optic nerve, threatening a person’s vision, so it’s important to diagnose and treat the condition as soon as possible.

How Is Thyroid Eye Disease Diagnosed and Monitored?

Thyroid eye disease is often diagnosed after a diagnosis of Graves’ disease. For example, if you see your primary care physician for an annual exam, you might also get lab work done that checks your thyroid function.

If you’ve been experiencing symptoms of hyperthyroidism — heat intolerance, trouble sleeping, rapid heartbeat, diarrhea, unintentional weight loss, or irritability, according to the National Institute of Diabetes and Digestive and Kidney Diseases  — that would also prompt your doctor to order thyroid testing.

Keep in mind that Graves’ disease is only one cause of an overactive thyroid. If you are diagnosed with Graves’, you should have a baseline eye exam done with an ophthalmologist, who can monitor your eyes for any developing problems.

Less often, people will develop eye problems before they develop thyroid abnormalities, says Kossler. The eye disease may even appear when the thyroid is not overactive, making it even more complicated, according to NORD.

“Thyroid eye disease is commonly misdiagnosed,” says Kossler. “It can take moderate or severe disease before it’s correctly diagnosed.” If you notice common signs and symptoms, such as eye pain, redness, swelling, or your eyes changing appearance, she recommends seeing an ophthalmologist to get lab work done to rule out thyroid eye disease.

When it comes to diagnosing the condition, an ophthalmologist can review symptoms and conduct a focused physical exam and may also suggest a computerized tomography (CT) scan to examine the optic nerve, says NORD.

How Is Thyroid Eye Disease Treated?

There are several treatment options for thyroid eye disease. “If you have thyroid eye disease, it’s extremely important to see your endocrinologist to get your thyroid under control,” says Kossler. This does not treat thyroid eye disease itself, she points out, but it’s an important first step.

Therapies to address eye symptoms depend on what stage your thyroid eye disease is in. There are many options to consider.

  • Selenium plays a key role in thyroid function. Research published in June 2014 in the journal Clinical Endocrinology found that people with Graves’ ophthalmopathy were lacking in the mineral compared with people who had Graves’ disease only, with no eye problems. Taking this antioxidant supplement may help decrease the progression of thyroid eye disease in people who have mild-to-moderate forms of the condition, says Kossler. Your doctor may also recommend eating Brazil nuts, which are naturally rich in the mineral.
  • Artificial tears can help relieve redness and dry eye.
  • Dark sunglasses can ease the effects of light sensitivity.
  • Prisms help address double vision, according to NORD. 
  • Steroids can help decrease inflammation, swelling, and puffiness.
  • Radiation can destroy tissue in the eye socket, but there are questions about its effectiveness in thyroid eye disease, notes NORD.
  • Surgery can correct eye and eyelid position. 
  • An eye infusion can help prevent inflammation and decrease proptosis (eye bulging).

The treatment that’s right for you will depend on whether you have a mild, moderate, or severe case of the disease, says Kossler, who notes that your doctor will also take your personal health history into consideration.

Thyroid eye disease sometimes subsides on its own, without treatment, says Kossler, so doctors will take a watch-and-wait approach with some people. But if the symptoms of thyroid eye disease are interfering with your quality of life, your doctor may recommend using artificial tears.

But if you’re experiencing eye bulging or vision changes, which are characteristics of a more advanced stage of the disease, you may want to consider surgery or eye infusions.



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