Warning Signs of Thyroid Eye Disease

Your thyroid gland produces hormones that control many processes in your body. In cases of thyroid disease, an autoimmune response causes your immune system to attack your thyroid cells. With thyroid eye disease, also known as Graves’ eye disease, the immune system also attacks cells in the eyes, causing bulging and other symptoms and eventual vision problems.

Orbital and oculoplastic surgeon Dr. Raymond Douglas provides diagnosis and care to new and existing patients from his state-of-the art offices in Beverly Hills, California. If you have thyroid eye disease, Dr. Douglas can diagnose your condition, and recommend the right treatment plan to restore the appearance and function of your eyes.

What is TED?

Thyroid Eye Disease (TED), also known as Graves’ eye disease, is an autoimmune disease closely linked to thyroid disease, especially Graves’ disease. When TED occurs, the immune system mistakenly targets the tissues around the eyes, causing inflammation, bulging and other symptoms that affect appearance and vision. While TED can be tough, proper diagnosis and treatment can help patients manage symptoms and get their eyes to look and function normally.

TED mainly affects people with hyperthyroidism, like Graves’ disease, but it can also occur in people with other thyroid conditions. Risk factors include smoking, radioactive iodine treatment and a family history of thyroid problems. TED goes through active and inactive stages, with active phases lasting up to 3 years. Some symptoms may improve over time, but severe cases often require medical intervention.

Prevalence and Risk Factors

Thyroid eye disease (TED) affects 0.25% of the population, with a huge difference between men and women. The disease occurs in 16 out of 100,000 women and 2.9 out of 100,000 men, making it more common in females. This is because women are more likely to develop hyperthyroidism, which is linked to TED. However, when TED becomes severe, the gender pattern changes. In the most severe cases, men are more affected than women, with a ratio of 1:4. This shows how the disease can affect different genders differently.

Common risk factors for developing TED include:

• Graves’ Disease: Most people with TED have Graves’ disease, a type of hyperthyroidism but TED can occur in people with other thyroid conditions.
• Family History of Thyroid Disorders: A family history of autoimmune thyroid disease can increase the risk of TED.
• Smoking: Smokers have a higher risk of getting TED and symptoms are more severe in smokers.
• Radioactive Iodine Treatment: This common treatment for hyperthyroidism has been linked to increased risk of TED in some patients.

What causes thyroid eye disease?

The most common reason people develop thyroid eye disease is an overactive thyroid caused by Graves’ disease. If you have this condition, your antibodies attack your thyroid gland, resulting in excessive activity in your thyroid.

For up to half of all patients with Graves’ disease, eye problems becomes an issue. The good news is that thyroid eye disease is typically treatable with professional diagnosis and care.

Thyroid eye disease can be a complication for people with already-diagnosed thyroid problems, or it might be the first issue that causes you to seek medical evaluation. These telltale signs and symptoms signal that thyroid eye disease could be a concern for your eyes.

Warning Signs and Symptoms of Thyroid Eye Disease

Knowing the symptoms and progression of TED is key to early diagnosis and management. Below is a list of TED symptoms and stages.

Visual and Sensory Symptoms of TED

TED causes a range of symptoms that affect the appearance and function of the eyes. Here are some of them:

1. Bulging Eyes (Proptosis): This is the most common symptom when inflammation and swelling in the eye muscles and tissues pushes the eyes out.
2. Grittiness and Tearing: Many patients feel like there’s sand in their eyes, with excessive tearing due to lacrimal gland inflammation.
3. Double Vision (Diplopia): As the eye muscles swell and stiffen, they can become misaligned and cause double vision.
4. Redness and Irritation: Eyes are often red and inflamed, especially in the morning or after prolonged eye strain.
5. Can’t Close Eyes: Swelling and bulging makes it hard to close the eyes fully, leading to dryness and corneal exposure.
6. Pain when moving eyes: As TED advances, patients feel pain when moving their eyes.

Severity Levels and When to Seek Treatment

TED symptoms vary in severity and typically progress through three main stages:

• Mild TED: Symptoms may include mild discomfort, a gritty sensation, and minimal tearing. Monitoring by a specialist may suffice for mild cases.
• Moderate TED: Symptoms intensify, with more pronounced bulging and double vision, often requiring treatments such as eye drops or anti-inflammatory medications.
• Severe TED: At this stage, TED can cause vision-threatening complications, such as corneal ulcers from incomplete eyelid closure and optic neuropathy. Immediate medical attention is essential for these severe symptoms to protect vision and prevent permanent damage.

Effective treatment options for thyroid eye disease

If you’re concerned about bulging eyes or other common symptoms of thyroid eye disease, get in touch with us for an evaluation and customized treatment plan. You may benefit from eye lubrication, anti-inflammatory medications. If bulging is severe, you may benefit from surgical orbital decompression to relieve pressure in your eye sockets.

Treatment Timeline and Common Therapies

TED treatment depends on the stage of the disease. Here are common therapies and a general treatment timeline for managing TED symptoms:

1. Anti-inflammatory Medications: Corticosteroids and other anti-inflammatory meds are used in the early stages of TED to reduce swelling and slow down the disease.
2. Tepezza: This FDA approved med targets the protein responsible for TED related inflammation and helps reduce symptoms in the active stage of the disease.
3. Orbital Decompression Surgery: For severe cases with significant eye bulging, this surgery relieves pressure on the optic nerve and gets the eyes back to normal position.
4. Prism Glasses and Eye Patching: For patients with double vision, prism glasses or eye patches may be prescribed to help with symptoms.
5. Radiation Therapy: Low-dose radiation to the eye area can help reduce inflammation and symptoms, but this is usually a secondary option.
6. Eyelid Surgery: Eyelid retraction surgery may be used to protect the cornea by allowing the eyes to close more fully and prevent corneal dryness and damage.

TED Treatment Timeline

The active phase of TED usually lasts between 1-3 years with different treatment phases:

1. Diagnosis and Early Intervention (0-6 months): Anti-inflammatory meds start here to manage early symptoms and prevent severe progression.
2. Symptom Management and Disease Stabilization (6-18 months): Tepezza or low dose radiation may be used during this phase to stabilize symptoms.
3. Corrective Surgery (After 18 months): Once the disease is stable, surgical options like orbital decompression or eyelid retraction surgery may be considered to address remaining symptoms and appearance.

Managing Lifestyle and Home Remedies

While professional treatment is necessary for TED, there are some things you can do at home to help with mild symptoms:

• Avoid Environmental Irritants: Smoke, wind and dust can exacerbate TED symptoms. Wearing sunglasses outside can help protect your eyes from environmental factors.
• Keep Your Eyes Moist: Using preservative free artificial tears or gels can keep your eyes comfortable, reduce irritation and protect the cornea from dryness.
• Use a Humidifier: Adding moisture to the air in your home can help prevent dry eyes, especially during colder months.
• Sleep with Your Head Elevated: Elevating your head at night can help reduce swelling around the eyes and ease morning discomfort.

By doing these, you can reduce discomfort and slow down symptom progression.

Seeking Help for Thyroid Eye Disease

If you experience any symptoms of TED, consult a specialist as early as possible. Regular check-ups are vital, especially if you have Graves’ disease or another thyroid condition. With the expertise and experience Dr. Douglas offers, you can protect your vision and address any aesthetic concerns related to your thyroid eye disease.

Schedule an appointment to speak with Dr. Douglas about your suspicious eye-related symptoms today. You can book online, or call now to make your appointment.