Thyroid Eye Disease (T.E.D.)
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for Western Australians
Thyroid eye disease is also known as Graves’ ophthalmopathy and is associated with
Graves’ disease (an autoimmune disease which causes an overactive thyroid) and
sometimes with Hashimoto’s thyroiditis (an autoimmune disease which causes an underactive
thyroid). However people with thyroid eye disease may not necessarily have autoimmune
thyroid disease, which leads researchers to think that thyroid eye disease and autoimmune
thyroid disease are two separate diseases. Sometimes the changes in the eyes may be
noticeable years before or after a person is diagnosed with Graves’ disease.


Symptoms/Signs of Thyroid Eye Disease
  • Sore ‘gritty’ dry eyes (inability to wear contact lenses)
  • Pain when moving the eyes (looking up, down and sideways)
  • Red eyes/eyelids
  • Pressure behind the eye
  • Lid retraction
  • Stare
  • Bulging eyes (caused by swelling in the eye socket (orbital tissues)
  • Double vision
  • Photophobia (light sensitivity)
  • Reduced vision in severe cases


Tests

The TSH receptor antibodies found in Graves’ disease are also found in people with thyroid
eye disease and TSH receptor antibodies have been found in the orbital tissues (eye
socket). Researchers don’t know what role these antibodies play in thyroid eye disease. No
specific gene has been identified either. It is possible that multiple genes are responsible for
thyroid eye disease.

The diagnosis can be based on clinical grounds. Typical features are usually fairly obvious. If
unsure then the following tests may be performed as well;
  • Thyroid function test including TSH, free T4 and free T3
  • Thyroid antibodies including TPO (thyroid peroxidase), anti-thyroglobulin and thyroid
    stimulating antibodies
  • Thyroid uptake scan
  • Orbital computed tomography
  • Magnetic resonance imaging


Treatment Options

Treatment for thyroid eye disease is usually managed by an ophthalmologist and
thyroidologist. Unfortunately the treatment for thyroid eye disease is often disappointing.
Smoking is a risk factor in developing thyroid eye disease and research has also shown that
smokers respond poorly to treatment. If no treatment is given then the condition may improve
on its own. It may take a few months or up to 3 years for the disease to run its course, but
generally the condition will partially or completely improve. If the disease has been inactive
for six months, then there is a good chance that the disease will not reoccur. In some cases
the disease may reoccur if thyroid hormone levels are poorly controlled. Radioactive iodine
(treatment for Graves’ disease) can aggravate existing thyroid eye disease or it can cause a
flare up and is therefore not recommended when you suffer from both Graves’ disease and
thyroid eye disease. Treatment options are as follows;


Supportive Care

Most people only need supportive care. If your eyes are dry and feel ‘gritty’ then you can get
lubricating eye drops from the pharmacy or you could try propping up the bed (by elevating
the head). Good quality sunglasses can help with light sensitivity and cool compresses can
temporarily reduce the inflammation. If you were diagnosed with autoimmune thyroid disease
(Graves’ disease or Hashimoto’s thyroiditis) then establishing normal thyroid function is
important as well.


Steroids

High doses of steroids are usually offered to reduce the inflammation for 4-6 weeks in the
active phase of the disease, but are often unsatisfactory and may come with other serious
side effects especially if used for a long period of time.


Orbital Radiotherapy

The effectiveness and safety of this treatment is being questioned by researchers. This
controversial treatment can produce unwanted side effects, which may not be obvious for
years. These include;
  • Cataracts
  • Radiation retinopathy (vision threatening complication)
  • Malignancy

Radiotherapy is not recommended for diabetic people with retinopathy. In some cases
steroids are used in combination with orbital radiotherapy.


Surgery

Surgery is usually only recommended for severe cases. The usual procedure is called
inferior orbital decompression, which may be followed by eye muscle surgery a few months
later. Eyelid surgery can be done at a later date to improve the appearance and function of
the eyes.

Disclaimer  The information provided is for educational purposes only and is not intended to be medical
advice. The contents must not be relied upon in place of advice and treatment from a qualified medical
practitioner. Thyroid WA Support Group Inc.and the author disclaim any liability whatsoever.
Copyright © Monique Atkinson 2011

Thyroid WA Support Group Inc.  -  ABN  84 263 220 330