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Thyroid Eye Disease: Symptoms, Treatment & Clinical Trial

Thyroid Eye Disease: Symptoms, Treatment & Clinical Trial

thyroid eye disease
©️ Alexandru Zdrobău on Unsplash
Dr. Natalie Bessom
Medically reviewed by

Dr. Natalie Bessom, D.O. Board-certified family medicine doctor with specialty training in nutrition, USA

Clinical Trial Recruiting for Thyroid Eye Disease

Are you age 18 or older, diagnosed with Thyroid Eye Disease, and interested in exploring possible clinical research options? Complete this study questionnaire to see if you’re eligible for an Thyroid Eye Disease clinical trial that is now enrolling: lpcu.re/ThyforLifeBlog

At ThyForLife, we are dedicated to finding new and innovative ways to improve the lives of those affected by Thyroid disorders. The study is simple and straightforward. By completing a quick and easy questionnaire, you’ll be able to see if you’re eligible for the trial.

If you’re interested in learning more and exploring possible clinical research options, we invite you to complete the questionnaire today to see if you qualify!

What is Thyroid Eye Disease?

Thyroid eye disease (TED), also known as Graves’ ophthalmopathy and orbitopathy, is a rare autoimmune condition that occurs when the body’s immune system attacks the tissues around the eye, causing inflammation and damage to the tissues of the eye.

The tissues affected include the eye (extraocular) muscles, fatty tissues, and connective tissues. In rare cases, this disease can result in loss of vision.

The precise mechanisms underlying the cause of this disease are not well understood currently. People with family members with the disease or some other autoimmune disease may have a higher genetic predisposition to developing this disease than other people.

TED can occur in people with hypothyroidism (thyroid underactivity), hyperthyroidism (thyroid overactivity), or euthyroidism (normal functioning of the thyroid) but is more common among people with Graves’ disease or some other hyperthyroid condition. Hyperthyroidism makes up about 90% of cases of TED.

Prevalence is also higher among women than men. The average age for TED is 43 years for all patients; however, one could be diagnosed as early as 8 years old or as late as 88 years old.

The clinical course of this disease is in two main phases—the progressive inflammatory phase, which can last for months to a few years, and the post-inflammatory stable phase.

TED can also significantly have a negative impact on your quality of life, especially in emotional and social aspects. Fluctuating thyroid hormone levels, typical of TED, could make one irritable and have mood swings. TED’s effect on the appearance of one’s eyes and visage could lead to social isolation and feelings of anger or depression.

This article will mainly discuss:

  • Some symptoms of TED
  • How to properly manage the disease to prevent the exacerbation of symptoms
  • The available treatment options for treating the disease

What are the symptoms of TED?

The symptoms of TED vary from one patient to the other, especially in severity. Patients are likely to be treated for other eye conditions instead of TED due to some similarities among these conditions, which sometimes makes TED challenging to diagnose.

However, unlike conditions such as hay fever and allergies, TED could occur outside the regular season for hay fever and typically doesn’t involve itchy eyes, unlike allergies.

To confirm you actually have TED, consult your doctor immediately if you notice some of the following symptoms, especially if you’ve already been diagnosed with a thyroid condition.

  • Blurry or double vision
  • Gritty sensations in the eye
  • Watery eyes
  • Swelling of eyelids
  • Eyelid retraction
  • Bulging eyes
  • Dry eyes
  • Painful eye movements and pain behind the eyes
  • Difficulty closing the eyes
  • Light sensitivity
  • Misalignment of the eyes (strabismus)
  • Headaches associated with progressive swelling of the eyeballs

How can TED be appropriately managed?

If you’ve been diagnosed with TED, you will have to be looked after by an ophthalmologist and an endocrinologist. Including a psychologist in the treatment plan is ideal, as TED tends to cause cosmetic changes, which may negatively impact the patient’s emotional and overall psychological well-being.

There are also some precautions you would do well to take to avoid aggravating your symptoms or slowing your treatment. If you’re a smoker, you should quit smoking as it worsens TED.

Research studies  have consistently linked cigarette smoking to the development and exacerbation of TED. Stress may also exacerbate the disease, so avoiding stress or stressful situations is essential.

Other lifestyle changes that help manage the disease include keeping your head higher than your body when sleeping in order to reduce the swelling of the eyes, wearing sunglasses, and taping your eyelids shut or using eye covers when sleeping to prevent further dryness of the eyes.

Radioactive iodine, a treatment for Graves’ disease or hyperthyroidism, has the propensity to worsen an active thyroid eye disease. This may be offset by supplementing this treatment with steroids under the recommendation of your healthcare provider.

What are the available treatment options?

While TED may be linked to some pre-existing thyroid condition, treating a thyroid disease does not result in the treatment of TED. However, conservative management options such as quitting smoking and maintaining normal thyroid hormone levels may help prevent symptoms from worsening. Treatment options include surgery, medications, or lifestyle changes.

The following are some effective treatment options for TED:

Teprotumumab: Clinical studies have shown that this biological infusion therapy effectively mitigates the symptoms of thyroid eye disease. In early 2020, teprotumumab-trbw (Tepezza®) became the first drug approved by the United States Food and Drug Administration (FDA) to treat adults with thyroid eye disease. It currently remains the only FDA-approved drug for TED treatment.

The drug works as a targeted inhibitor of the insulin-like growth factor-1 (IGF1-R), a protein that is instrumental in the development of the disease. This medication has proven to be effective in the abatement of typical TED symptoms and has improved the overall quality of life of affected individuals taking the drug.

Surgery: While treatment during the active phase of the disease is targeted at preserving sight and the integrity of the cornea, treatment within the second phase when the inflammation has resolved, typically involves the treatment of certain permanent changes, which would generally require surgery for rehabilitative therapeutic outcomes such as the correction of double vision or reduction in the retraction of the eyelids.

There are different surgical options suited for different conditions of the eye. Some of such surgical options are outlined as follows:

  • Orbital decompression surgery: This surgical procedure removes bone and soft tissue from behind the eye to create more space and to help return the eye to a normal position within its socket. This surgical option may also be employed in the active phase of TED for the relief of optic neuropathy and reduction in congestion and inflammation of the eye, effectively reducing the bulging of the eye. Orbital decompression surgery is typically performed in advance of eyelid surgery or eye muscle surgery, if necessary.
  • Eyelid surgery: Your doctors may recommend eyelid surgery to get your eyelids back into a normal position if they pull back too much. This surgical procedure helps improve the appearance and function of the eyelids. Since the tightened muscles in the eyelids make closing the eyelids difficult, leaving the cornea (front of the eye) exposed, eyelid surgery helps decrease corneal exposure and irritation.
  • Eye muscle surgery: This procedure is essential for correcting severe double vision by repositioning the affected muscles around the eyes farther back from their original positions on the eye. This surgical procedure may have to be performed more than once for optimal results.

Steroid medication: Loss of vision or double vision may be treated, for a limited period, with prednisone, a systemic corticosteroid (cortisone-like drug or steroid) that is capable of suppressing autoimmune inflammation. Treatment with prednisone for an extended period is likely to yield adverse side effects on the individual.

Orbital inflammation can be reduced with appropriate doses of oral prednisone or intravenous methylprednisolone. Treatment with prednisone also reduces swelling behind the eyes.

Lifestyle changes: Aside from quitting cigarette smoking, certain lifestyle changes could be effective in treating TED by easing some of the usual symptoms depending on the severity of the disease.

For instance, dark sunglasses could be used to manage light sensitivity to treat mild cases of TED. Over-the-counter eye drops (artificial tears), gels, and ointments can be used to treat dry or irritated eyes. Taking over-the-counter selenium supplements can also help mitigate TED symptoms.

Special prescription lenses known as prism prescription can correct double vision. Some people also opt for an eyepatch on one eye to manage their double vision.

Radiation: In some instances, radiation might be recommended as a treatment option for TED to reduce swelling in tissues around the eye, including muscle tissues. Radiation therapy may be recommended for patients who respond to prednisone to mitigate double vision and loss of vision in severe cases.

The downside to this treatment option is that it may be limited in its abatement of the symptoms of TED and may result in ocular dryness. It is also not advisable to be used more than twice in one’s lifetime as it has the propensity to result in tumors.

Clinical Trial Recruiting for Thyroid Eye Disease

Are you age 18 or older, diagnosed with Thyroid Eye Disease, and interested in exploring possible clinical research options? Complete this study questionnaire to see if you’re eligible for an Thyroid Eye Disease clinical trial that is now enrolling: lpcu.re/ThyforLifeBlog

At ThyForLife, we are dedicated to finding new and innovative ways to improve the lives of those affected by Thyroid disorders. The study is simple and straightforward. By completing a quick and easy questionnaire, you’ll be able to see if you’re eligible for the trial.

If you’re interested in learning more and exploring possible clinical research options, we invite you to complete the questionnaire today to see if you qualify!

Key Takeaways

  • Thyroid eye disease (TED) is an autoimmune condition that causes inflammation and damage to the tissues of the eye. About 90% of people with TED are also hyperthyroid. The inflammatory and stable phases constitute the two phases of the course of this disease.
  • Some typical symptoms of TED include blurry or double vision, dry or watery eyes, retraction of eyelids, bulging eyes, and painful eye movements.
  • Besides medication, surgery and radiation therapy, some lifestyle changes can help effectively mitigate the symptoms of this disease.
  • Cigarette smokers are at a high risk of developing this condition. It is, therefore, imperative to quit smoking to prevent the worsening of your symptoms.
  • Although Graves’ disease and Graves’ ophthalmopathy (thyroid eye disease) are both autoimmune diseases, one is not directly caused by the other, so the treatment of one does not result in the treatment of the other.
  • Teprotumumab, an FDA-approved drug for treating adults with thyroid eye disease, works by blocking the protein IGF1-R and inhibiting its role in the development of TED. Prior to its approval in 2020 by the FDA, clinical studies showed it was effective in alleviating the symptoms of the disease.
  • A Thyroid Eye Disease clinical research opportunity is available to our community! If interested in learning more, complete this study eligibility questionnaire.

FAQs

Thyroid eye disease, also known as Graves’ orbitopathy or Graves’ ophthalmopathy, is an autoimmune condition where the immune system mistakenly attacks the muscles and tissues around the eyes. It often occurs in individuals with Graves’ disease, an autoimmune thyroid condition.

Common symptoms of thyroid eye disease include bulging eyes (proptosis), double vision (diplopia), eye pain, redness, swelling, and difficulty closing the eyes completely. In severe cases, it can lead to vision loss or permanent eye damage if left untreated.

Treatment for thyroid eye disease aims to manage symptoms and prevent complications. Depending on the severity, treatment options may include medications such as corticosteroids to reduce inflammation, eye drops to lubricate the eyes, or surgery to correct eye misalignment or relieve pressure on the optic nerve.

Disclaimer

At ThyForLife, we do our utmost to provide accurate information. For detailed medical information regarding diagnosis, treatment, and general practices please consult your healthcare professional. Always listen to the advice of your healthcare provider.
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