Thyroid Eye Disease

Question 1

What causes thyroid eye disease

Answer 1

Occurs in the context of graves - due to autoimmune response to auto antigen such as TSH receptor. Some of these receptors are found in the eye therefore we get retro-orbital inflammation, causing deposition of glycosaminoglycan and collagen in the eye

Question 2

What are the features of TED

Answer 2

• Exophthalmos
• Conjunctival oedema
• Optic disc swelling
• Ophthalmoplegia
• Inability to close eyelids - can lead to exposure keratopathy

Question 3

What are the risk factors for TED

Answer 3

• Smoking is the biggest risk factor
• Radioiodine treatment is a relative contraindication with Grave’s management as it may cause TED

Question 4

How do we manage TED

Answer 4

• Steroids
• Radiotherapy
• Topical lubricants to relieve corneal inflammation from exposure

Question 5

When do we refer TED to ophthalmologist for urgent review?

Answer 5

• Unexplained worsening of vision
• Globe subluxation (popping out)
• Disc swelling
• Change in intensity/ colour vision
• Cornea still visible when eyelids close