Thyroid conditions are common in the United States, with hyperthyroidism (an overactive thyroid), hypothyroidism (an underactive thyroid), and Graves’ disease leading as the top three. More than a quarter of people who have underlying thyroid disorders will experience thyroid orbitopathy, also known as thyroid eye disease (TED). For those affected, symptoms can range from mild discomfort to severe eye symptoms and complications, like bulging eyes, double vision, and, in rare cases, vision loss. Thyroid eye disease is known to have caused hearing loss and lid retraction because of excess inflammation.
If you’re experiencing swelling around your eyes, double vision, or significant hearing changes, you may be dealing with more than routine aging and allergies. Your body’s overzealous immune system fuels thyroid orbitopathy. It attacks your tissue, especially around the eyes, causing thyroid eye disease, which could worsen without treatment or a manageable care plan.
Thankfully, breakthrough treatments like TEPEZZA® provide hope for ophthalmology patients with a condition once thought to be entirely untreatable.
What is Thyroid Orbitopathy?
Thyroid orbitopathy is an autoimmune condition notorious for wreaking havoc within and surrounding the eyes. Often linked to thyroid conditions like Graves’ disease, it occurs when your immune system attacks the fatty and muscular tissue behind the eyes, placing pressure on the optic nerve. This results in inflammation and tissue expansion, which can cause protruding (bulging) eyes and subsequent dryness, presenting as redness, light sensitivity, and pain.
In severe cases, compression of enlarged muscles behind the eye on the optic nerve may lead to vision loss, and may also cause double vision due to impaired movement of the enlarged and often stiff eye muscles.
What Causes Thyroid Orbitopathy?
Thyroid orbitopathy occurs when the immune system goes rogue and attacks healthy tissue. It targets soft tissues and muscles, but what triggers this immune rebellion?
- Faulty autoantibodies. Your immune system makes special proteins called autoantibodies that go after your thyroid and soft tissues. This causes inflammation, swelling, and scarring, leading to uncomfortable (sometimes permanent) symptoms.
- Thyroid conditions. Most people with thyroid eye disease have Graves’ disease, which makes the thyroid overactive. However, it can also show up with other thyroid problems, like an underactive thyroid or after specific thyroid-affecting treatments for unrelated conditions.
- Smoking. This damages more than your lungs; it can significantly worsen thyroid conditions, resulting in TED. Quitting smoking could make a positive difference if you’re experiencing painful symptoms.
- Family genes. If autoimmune diseases run in your family, you have a higher chance of developing an autoimmune condition. Your genetic makeup could be stepping the stage for how your immune system acts.
- Life stress and triggers. Stress, infections, or hormonal changes can push your body into overdrive, triggering thyroid orbitopathy. It’s often a combination of factors that causes your immune system to panic and spiral out of control.
To summarize, a mix of internal and external forces turns your immune system against you. While frustrating, challenging, and often painful, understanding these causes can help you and your medical team create a plan to reclaim your health.
New Research Suggests a Connection Between Hearing and TED
With a name like thyroid eye disease, you’d expect vision problems and issues with eye tissue. However, new research suggests everything is connected, and TED can affect hearing. Many patients report tinnitus (an annoying, constant ringing sound), hearing loss, or a sensation of fullness in the ears.
According to studies by Raymond Douglas, Thyroid Eye disease-related inflammation can put pressure on the middle and inner ears, leading to fluid buildup and pressure changes. It would feel like you have a terrible cold at first, but it may worsen over time.
While hearing problems aren’t the norm for every TED-afflicted patient, they’re a symptom to check for because they could indicate a spreading of inflammation and worsening thyroid orbitopathy.
TEPEZZA®: A Game-Changer for Thyroid Eye Disease Treatment
TEPEZZA® is a groundbreaking drug that treats thyroid orbitopathy from the cause. Teprotumumab, also known as TEPEZZA®, is a monoclonal antibody that blocks the IGF-1R pathway, which plays a key role in the immune system’s attack on the tissues around the eyes. A monoclonal antibody is a lab-made protein that mimics the immune system by targeting a specific molecule, helping to block or modify disease-causing processes in the body.
TEPEZZA® works by reducing inflammation, decreasing swelling in the tissues around the eyes, and helping to prevent excessive scarring. By targeting the underlying autoimmune process, it can improve eye movement, reduce bulging, and alleviate other symptoms of Thyroid Eye Disease (TED). The medication often reverses visible and functional damage, helping patients reclaim health and normalcy without pain or discomfort.
The Impact of TEPEZZA® on Quality of Life
If you’ve ever avoided taking selfies, looking in the mirror, or socializing because of thyroid orbitopathy’s cosmetic symptoms, you’re not alone. TED can be detrimental to your confidence.
Luckily, TEPEZZA® dramatically improves physical symptoms like bulging eyes and redness. Beyond physical benefits, many patients reported feeling like themselves again, enabling them to be more socially adventurous and emotionally engaged.
When is TEPEZZA® the Right Treatment Option?
Timing is essential for TEPEZZA®, as it works best during the active phase of thyroid orbitopathy, though can be effective in many patients who have had the disease for a longer time. Flare-ups can last from six months to two years and may present severe symptoms like optic nerve compression and double vision.
Tepezza has been linked to hearing-related side effects, including tinnitus, hearing loss, and changes in sound perception. Research suggests that these effects may be due to the drug’s impact on the IGF-1R pathway, which is involved in inner ear function. Since patients with TED are already at a higher risk of hearing impairment, regular hearing screenings before and during treatment are essential. Monitoring for auditory changes can help ensure early detection and intervention, improving overall patient care.
Remember—TEPEZZA® isn’t for everyone. Like any medication, there’s trial and error and side effects, and you may find treatment doesn’t work as well for you as you had hoped. Your healthcare team will consider the severity of your symptoms, overall health, and response to other treatments before recommending TEPEZZA®.
Managing the Signs and Symptoms of Orbitopathy During and After Treatment
- Use high-quality artificial tears to keep your eyes moisturized and reduce dryness.
- Wear lightweight sunglasses to protect your eyes from UV rays, wind, and bright lights.
- Avoid smoking, as it can worsen symptoms and interfere with treatment effectiveness.
- Sleep with your head slightly elevated to reduce swelling around your eyes.
- Stay consistent with your medications and follow doctor treatment plans closely.
- Maintain regular checkups with your ophthalmologist and endocrinologist to monitor TED and the progress of your thyroid condition.
- Use a humidifier at home to add moisture to the air and ease discomfort.
- Practice stress management techniques like relaxing yoga and meditation to support overall well-being.
Looking Ahead: Advances in Thyroid Orbitopathy Care and Treatments
While TEPEZZA® is the only FDA-approved medical therapy for TED, research is ongoing on alternate therapies and pathways that may be targeted. Scientists are exploring personalized medicine approaches, new biologics, and minimally invasive surgical options to give patients more choices in the future.
For now, TEPEZZA® is a beacon of hope for those grappling with a complex, painful condition. Battling the signs, symptoms, and emotional toll of thyroid orbitopathy is challenging, but there’s help out there, and it’s only getting better.
Sources:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10818043/
