Thyroid Eye Disease

Question 1

Definition of thyroid eye disease

Answer 1

Inflammation of the tissue around the eye, seen in those with Graves’ disease

Question 2

Aetiology of thyroid eye disease

Answer 2

• Thyroid eye disease affects 25-50% of patients with Graves’ disease
• Can be the first presenting symptom of Graves’ disease

• Smoking is the biggest RISK FACTOR

Question 3

Pathophysiology of thyroid eye disease

Answer 3

• Eye disease may NOT correlate with thyroid disease (patient can be euthyroid, hypo- or hyperthyroid)

• Thought to be caused by autoimmune response to TSH receptors found in eye due to TSH receptor autoantibodies
• This results in retro-orbital inflammation and lymphocyte infiltration (causes swelling of eye)

Question 4

History and Examination of thyroid eye disease

Answer 4

• Eye discomfort
• Grittiness
• Increased tear production
• Photophobia
• Reduced visual acuity
• Diplopia
• Optic nerve compression?
• Exopthalmos: look down from forehead to see eye protrude
• Conjunctival oedema
• Papilloedema
• Opthalmoplegia: unable to do upward gaze due to muscle swelling and fibrosis

Question 5

Investigations for thyroid eye disease

Answer 5

• Clinical diagnosis
• TSH
• Anti-TSH receptors
• T4

Question 6

Treatment of thyroid eye disease

Answer 6

• Treat hyper- or hypothyroidism
• Smoking cessation
• Artifical tears/topical lubricants to reduce dryness and prevent corneal inflammation
• Sunglasses, avoid dust etc

Serious cases:
• High dose steroids (methylprednisolone)
• May need surgical decompression if severe risk to eye sight
• Radiotherapy?

Question 7

Prevention of thyroid eye disease

Answer 7

• Smoking is the biggest modifiable risk factor
• Radioiodine treatment can increase the inflammatory symptoms of thyroid eye disease (steroids can reduce the risk)

Question 8

Complications of thyroid eye disease

Answer 8

• Exopthalmos
• Conjunctival oedema
• Opthalmoplegia
• Papilloedema
• Eyesight deterioration