A Guide to Understanding Thyroid Eye Disease (TED)

Thyroid Eye Disease (TED), also known as Graves' Ophthalmopathy, is a rare autoimmune disorder that affects the eyes. This condition is commonly associated with an overactive thyroid gland (hyperthyroidism) due to Graves' Disease, but can also occur in patients with an underactive gland (hypothyroidism). 

Although it is not life-threatening, this disease can cause serious symptoms in the eyes, including swelling, redness, and bulging eyes. If left untreated, it can lead to permanent vision loss. 

Understanding the causes, symptoms, diagnosis, and treatment options can help you manage this eye condition. 

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Causes of Thyroid Eye Disease

According to the American Thyroid Association, one in every three people with Graves's disease develop eye symptoms. That's because Graves' disease, an autoimmune disorder causing hyperthyroidism, can cause the body to produce an antibody called Thyroid-Stimulating Immunoglobulin (TSI) that can affect the thyroid's hormone production. In some cases, this overactivity of hormones leads to further developing antibodies, which attack eye muscles and tissues (Thyroid Eye Disease). 

Though rare, TED can affect individuals with hypothyroidism or Hashimoto's disease, a condition where the immune system attacks the thyroid gland. 

Researchers also believe genetics and lifestyle, like stress and smoking, are risk factors for developing Thyroid Eye Disease. 

Symptoms of Thyroid Eye Disease

The symptoms of Thyroid Eye Disease vary significantly from person to person and can range from mild to severe. 

Some common symptoms of TED include:

• Red, swollen, or inflamed eyes

• Bulging eyes (proptosis)

• Feeling of grittiness in the eyes

• Dry eyes

• Double vision

• Eye pain or discomfort

• Sensitivity to light

More severe symptoms can occur, such as:

• Inability to fully close eyelids

• A change in how you see colors

• Vision loss

If you experience any of the above three, you should seek medical treatment immediately. 

Diagnosing Thyroid Eye Disease

Diagnosing Thyroid Eye Disease involves a thorough eye exam and medical history review. Your primary care doctor, endocrinologist, or ophthalmologist may also order additional tests to confirm the diagnosis, such as:

• Blood tests to check thyroid hormone levels

• CT scan or MRI to view the eye sockets and tissues

• Visual acuity test to measure vision loss

• A color vision test 

While Thyroid Eye Disease is typically mild, diagnosing and treating this condition early is essential to prevent permanent vision loss.

Treating Thyroid Eye Disease

The treatment of Thyroid Eye Disease depends on the severity of the symptoms, the underlying cause, and your overall health. There are various treatment options available, including:

• Artificial tears or lubricants- These can help relieve dryness, irritation, and redness in the eyes.

• Selenium supplementation- An oral medication that can help with mild symptoms. 

• Steroid medications- Corticosteroids, like Solu-Medrol, can help reduce inflammation and swelling in the eyes.

• Radiation therapy-This is often used with steroids, especially for patients with moderate to severe symptoms.

• Teprotumumab- Medication is given through IV to help reduce irritation and bulging of the eye. 

• Surgery- In severe cases, surgery may be necessary to realign the eyes, relieve pressure, or restore vision.

Final thoughts

Thyroid Eye Disease (TED) is a rare autoimmune disorder that affects the eyes and can lead to serious symptoms and vision loss if left untreated. However, early diagnosis, proper treatment, and lifestyle changes can help prevent further eye damage and improve overall quality of life. 

If you are experiencing symptoms associated with this condition, it's important to schedule an appointment with your primary care physician, thyroid doctor (endocrinologist), or ophthalmologist as soon as possible. 

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