Some people with a thyroid gland disorder may develop thyroid eye disease.

Patients with a thyroid gland disorder may want to check with an eye doctor whether they have Thyroid Eye Disease (TED). Some of the symptoms include dry eyes, watery eyes, bulging eyes, double vision and a “staring” look.

TED is a disorder of the eye and its surrounding tissue. It is related to immune disorders of the thyroid gland and can affect up to 40 per cent of people with thyroid gland disorder.

“If the thyroid gland disorder begins at an older age, the person is more likely to be affected by TED. It is also five times more likely to affe​ct females than males, although the disease tends to be more severe in males,” said Dr Livia Teo​, Consultant, ​Oculoplastic Department, Singapore National Eye Centre​ (SNEC).

What causes Thyroid Eye Disease (TED)?

Studies show that the disease may be linked to genetic factors, and that these genes may be hereditary. Other triggers are lifestyle factors such as stress. Smokers are also at a higher risk of TED as the immune cells responsible for the inflammatory response in the body are activated by chemicals in cigarette smoke. “These immune cells are stimulated to produce excessive amounts of protein, sugar and fat deposits, which can result in TED ,” said Dr Teo.

People with diabetes also run a risk. “As Type 1 Diabetes is an autoimmune disorder, with a genetic component to it, it is likely that the immune system of diabetics is prone to developing other immune related diseases like TED ,” said Dr Teo.

TED can affect the eye, eyelids and eye orbit (the muscle, fat and bone around the eyeball). This can change a person’s appearance by causing raised eyelids which results in a “staring” appearance, or proptosis, which is the bulging forwards of one eye or both eyes.

If it affects the eye muscles, it can cause misalignment, which can result in double vision. “Sight-threatening complications from the disease include a corneal ulcer, as a result of poor eye closure over the protruding eye, glaucoma, and optic nerve compression. But such complications are rare,” said Dr Teo.

Treatments for Thyroid Eye Disease (TED):

Treatment for mild TED usually begins with the use of eye drops and an eye ointment to lubricate the eyes and prevent corneal ulcers. High eye pressure can be treated with the same eye drops that are used to lower pressure in glaucoma.

Dr Teo said that to reduce inflammation, oral selenium, an antioxidant vitamin, can also be used. In moderate to severe TED​​, immunosuppressants (medications that suppress the immune system, including steroids and chemotherapy drugs) are usually needed. “As TED is a result of a disorder or hyperactivity of the immune system, immune suppressing medication such as steroids will help to regulate this problem,” Dr Teo said.

Another mainstream treatment used in moderate and severe cases of TED to help to reduce the inflammation in the orbital tissue, is orbital radiotherapy. This is used to treat active cases of TED by destroying the white blood cells infiltrating the tissue around the eyeballs.

Fortunately, only 5 per cent of patients with TED will have a severe form of the disease. “Treatment is tailored to individual patients and can be effective in preventing vision loss and complications arising from the disease,” said Dr Teo.

However, some patients may experience side effects from steroid medicines. They may become more susceptible to infections, and experience raised blood sugar and blood pressure levels, gastritis, insomnia, mood changes, increased appetite with weight gain, skin thinning and osteoporosis. Less common but serious side effects include heart rhythm irregularity and bleeding stomach ulcers.

The “staring” appearance or bulging eyes formed as a result of the disease can be rectified with surgery. “If the eyes are protruding too much, we can do elective orbital decompression surgery to let the eye move back into the eye socket. If the bulgy look is due to eyelids that are raised too high, we can do eyelid surgery to lower the eyelids and improve the appearance,” said Dr Teo.

The disease, which usually lasts from 18 to 24 months, can be emotionally distressing as it affects a patient’s quality of life. But it will eventually stabilise with treatment, although there is a chance of relapse.

Dr Teo advises patients to comply with treatment and attend follow-up consultations after recovery. “Early detection and management of TED will lead to a better functional and cosmetic outcome. And avoiding smoking, including second-hand smoke, and a stressful lifestyle, can help to prevent the disease,” she said.

TED stats:

  1. TED is a disorder of the eye and its surrounding tissue. It can affect up to 40% of people with thyroid gland disorder
  2. TED is 5X more likely to affect females than males, although the disease tends to be more severe in males
  3. The disease, which usually lasts from 18-24 months, can be emotionally distressing as it affects a patient's quality of life
  4. Only 50% of patients with TED will have a severe form of the disease

Ref: Q15