June 15, 2024

Thyroid eye disease (TED) is an autoimmune condition that causes swelling and damage to the tissues around your eyes. There are two phases of TED: an active phase and an inactive phase. The active phase consists of progressive swelling and eye tissue changes. The inactive phase is when the disease progression slows down and eventually stops, however, the damage from the active phase remains. The active phase can last anywhere from 6 months to 2 years.

Thyroid eye disease is most common in people with Graves’ disease—a condition that occurs when your thyroid glands produce too much thyroid hormone. Though less rare, people without an underlying thyroid disease can also develop TED.

The symptoms of TED range from mild to severe and may vary from one person to another. In most cases, you’ll develop symptoms in both eyes. But sometimes, one eye may have worse symptoms than the other.

Common symptoms of thyroid eye disease include:

In serious cases, excessive swelling can cause excess pressure on your eyes, resulting in the compression of the optic nerve. The optic nerve is the main eye nerve that carries visual nerve impulses to the brain to help you see. If not treated properly, this condition can result in progressive loss of vision.

Thyroid eye disease is an autoimmune disorder which means the immune system begins to attack healthy tissues in your body by mistake. The exact cause of most autoimmune conditions is not yet completely understood by researchers.

In people with Graves’ disease, the immune system develops an abnormal antibody known as thyroid-stimulating immunoglobulin which mimics the function of thyroid-stimulating hormone (TSH)—a hormone that helps regulate metabolism. These abnormal antibodies also affect the tissues surrounding the eyes since eye tissues consist of proteins similar to the ones found in the thyroid gland.

It’s worth noting that not everyone with thyroid eye disease has Graves’ disease. This suggests that other factors can also cause thyroid eye disease. Some things that can increase your risk of this condition include:

  • Being assigned female at birth
  • Having a family history of TED
  • Smoking cigarettes or using other tobacco products
  • Undergoing radioactive iodine therapy
  • Living with underlying health conditions such as rheumatoid arthritis or type 1 diabetes

If you’re experiencing symptoms of TED or have an underlying thyroid condition, it’s important to see your eye care specialist (such as an optometrist or ophthalmologist) for testing and your primary care provider for support.

At your eye appointment, your eye care specialist will ask you about your symptoms and personal and family health history. They will also conduct a standard physical exam. After this, your eye care specialist may order additional tests, such as:

  • Eye bulging test: Measures the extent of your eye bulging using a device called an exophthalmometer
  • Color vision test: Tests your ability to distinguish different colors
  • Visual field test: Determines if you have blind spots (areas where you are unable to see)
  • Imaging tests: Imaging tests such as magnetic resonance imaging (MRI) or computed tomography (CT scan) take detailed images of your eye sockets and muscles to identify swelling around your eye tissues and optic nerve

Your eye care specialist may also refer you to an endocrinologist (a doctor who specializes in hormonal conditions) to get your thyroid levels checked, especially if you do not currently have a diagnosis for Graves’ disease or other underlying thyroid conditions. An endocrinologist will likely use blood testing to check thyroid levels or measure antibodies that can confirm the diagnosis for thyroid eye disease.

Treatment of thyroid eye disease often involves reversing the underlying thyroid condition—especially if you have Graves’ disease. Keep in mind: treating Graves’ disease doesn’t always completely get rid of symptoms of TED, but may help you better manage the condition.

At-Home Remedies

For mild cases of TED, your eye care specialist may recommend the following treatment options:

  • Using lubricating eye drops or artificial tears to reduce dry eyes
  • Applying cool compresses to the eyes to reduce swelling and irritation
  • Wearing sunglasses to prevent light sensitivity
  • Quitting smoking because it can worsen TED symptoms

Medications

If your condition is more serious, your healthcare team (which may include your eye care specialist, primary care provider, and endocrinologist) may recommend medications or surgery. Commonly prescribed medications for TED include:

  • Tepezza (teprotumumab): An intravenous (IV) injection that can help reduce eye bulging and irritation
  • Rayos (prednisone): A corticosteroid drug that may help improve eye swelling

Surgery

Your healthcare team may only recommend surgery if you have severe symptoms of TED. If surgery is an option for you, your care team will usually perform the surgery during the inactive phase of the condition, where symptoms are reduced. You might need surgery during an active phase only if you have a risk of vision loss. There are different surgical options for TED and the exact procedure you need will depend on the severity of your condition. Options include:

  • Orbital decompression surgery: Helps reduce eye bulging and improve vision problems if your optic nerve is compressed
  • Eyelid surgery: Repositions your eyelid to reduce irritation
  • Eye muscle surgery: Corrects double vision that may occur as a result of thyroid eye disease

Because thyroid eye disease is an autoimmune condition, strategies to prevent TED are limited. However, quitting smoking, limiting secondhand smoke, and avoiding iodine therapy may help lower your risk of this condition.

It’s essential to receive proper treatment for TED. If left untreated, thyroid eye disease can lead to serious complications. A few of these complications include:

  • Optic atrophy: Shrinks the optic nerve and causes serious vision impairments
  • Exposure-keratopathy: Damages the cornea and causes dry eyes, often occurring due to difficulty closing eyelids properly
  • Persistent proptosis: Causes persistent bulging of the eyes which can lead to permanent cosmetic changes to the eyes and overall facial appearance
  • Open-angle glaucoma: Results in reduced vision or blindness due to optic nerve damage

The severity of thyroid eye disease varies from one person to the next. While the active phase lasts from six months to two years, the inactive phase generally improves swelling and slows down the progression of the condition. Most people experience mild cases of thyroid eye disease that goes away with home remedies. Only 5% to 20% of people require medication or surgery to treat the condition. To learn what treatment approaches are right for you, your healthcare team is best fit to tell you about your options.

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