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Health and Disease

Thyroid Eye Disease: Symptoms, Diagnosis, and Treatment

Thyroid eye disease is an autoimmune condition in which the eye muscles and fatty tissue behind the eye become inflamed. Learn about the diagnosis and symptoms of this disease and what current treatment there is for TED.

Introduction

Thyroid eye disease, also known as Graves’ eye disease, is an autoimmune condition in which the eye muscles and fatty tissue behind the eye become inflamed. The main symptoms of thyroid eye are red, uncomfortable, and “bulging eyes.” These are caused by inflammation of the eyelid, tear glands, muscles, and fatty tissue behind the eye. Occasionally, this inflammation can lead to stiffness in the muscles, which can cause double, or blurred vision, as eyesight is not aligned between both eyes due to not being able to move parts of the muscle. Thyroid eye is an autoimmune disease caused by an immune attack on the tissue around the eye, irritating it and causing inflammation. 

Most people suffering from thyroid eye disorder (or TED) have Graves’ disease, which can detrimentally affect the thyroid gland, usually causing hyperthyroidism (overactive thyroid). 25% of those with Graves’ disease will also develop TED sometime before or during treatment.  Those suffering from Graves’ disease will double their chances of developing TED by smoking. A person diagnosed with thyroid eye will likely be placed under the care of an endocrinologist (a doctor specializing in hormonal diseases) as well as an ophthalmologist (an eye doctor). These departments will be the first port of call during treatment and should be informed if symptoms worsen.

Symptoms and Diagnosis

One major issue associated with TED is how difficult it is to diagnose. Thyroid eye is usually mistaken for symptoms associated with hayfever, conjunctivitis, or allergies. There are signs that directly point to TED and not the aforementioned conditions: continuing symptoms all year around with no improvement in winter months, no stickiness around the eye, and no improvement of symptoms after trialling different allergy solutions. 

In order to reduce symptoms of thyroid eye, it is imperative the sufferer attempts to quit smoking, if they are in the habit. Furthermore, it is important that they listen to their doctor’s advice and are aware of their changing thyroid levels, as well as monitoring them and following medical advice (e.g. attending blood tests every six months). This can sometimes help to alleviate symptoms and reduce the chance of TED becoming more severe.

It is vital to recognize that TED massively impacts individuals’ lives. From self confidence, to eyesight, thyroid eye can affect your daily life. Many sufferers struggle with low self esteem and self consciousness due to their eyes having a “bulging” appearance. Double vision can also be frustrating, meaning those with thyroid eye can experience confusion, especially when reading or trying to understand someone’s facial expression. This can be taxing on the patient, as well as family and friends, so it is crucial that everyone researches how they can support their loved one. Charities such as the “Thyroid Eye Disease Charitable Trust” and the “British Thyroid Foundation” can offer support and advice to help patients come to terms with the condition and adapt their daily life for ease. 

Treatment

There are a range of different treatments to help with some painful symptoms of TED. Artificial tears can be used to reduce the feeling of “grit in the eye” that can be associated with thyroid eye disease. If inflammation is severe, a doctor may prescribe an oral steroid to reduce it, or administer steroids intravenously. Some patients also find that having prisms attached to glasses can reduce their double vision. There are also surgical options to fix double vision, protect the eyelids, create space in order to allow the eye to close better, and protect the eyeball. 

The best thing a family member can do for a loved one suffering from TED is support and listen to them. Any disease affecting eyesight can be extremely unnerving for the sufferer, as their independence decreases, they may have to become more reliant on those around them. Especially for adults, double vision can be frustrating as it makes day to day activities harder. Teenagers and young people may feel self-conscious about their appearances and the possibility of having to wear an eye patch to alleviate vision problems. A caretaker, friend, or relative, should offer help, but make sure to give them space and allow their loved one to attempt things independently. They should be careful not to sound condescending, be supportive, and if they are comfortable discussing it, talk to them about the condition and their emotions surrounding it. Before forcing their help upon someone, those close to a person with thyroid eye should communicate with them and ask what they would like you to do.

References

Douglas, Raymond S. “Thyroid Eye Disease (TED or Graves Eye Disease).” Thyroid Eye Disease (TED or Graves Eye Disease) | Kellogg Eye Center | Michigan Medicine, http://www.umkelloggeye.org/conditions-treatments/thyroid-eye-disease.

“Graves’ Eye Disease.” American Thyroid Association, http://www.thyroid.org/graves-eye-disease/.

MacEwen, Caroline. “Expert Opinion – Diagnosing Thyroid Eye Disease.” GP, GP, 14 Mar. 2012, http://www.gponline.com/expert-opinion-diagnosing-thyroid-eye-disease/ophthalmology/article/1120742.

“Thyroid Eye Disease.” British Thyroid Foundation, 2019, http://www.btf-thyroid.org/thyroid-eye-disease-leaflet.

“Thyroid Eye Disease.” Cleveland Clinic, my.clevelandclinic.org/health/diseases/17558-thyroid-eye-disease. 

Sophie Farr, Youth Medical Journal 2020

By Sophie Farr

I am a student from the UK and my ambition is to become a doctor.

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