THYROID EYE DISEASE (July 2013)
The eye muscles can be damaged
by the same process that can affect the thyroid gland. That is why thyroid hormone imbalance is
frequently associated with eye problems. The usual explanation: antibodies to
thyroid tissue have 2 separate effects:
1. They damage thyroid tissue
causing hormone imbalance; this threatens your health, and ….
2. They also damage eye
muscles.
Effects of Thyroid Eye
Disease
1. Double vision
(diplopia). The abnormal thyroid
status alters the eye muscles that move the eye.
2. Proptosis (bulgy
eye). Due to swelling of the
muscles around the eye and of the fatty tissues around the eye.
3.
Lid retraction. Due to
excessive stimulation of a muscle in the upper lid by thyroid
hormone.
4. Optic nerve compression. This is serious and potentially
blinding. It is very rare. If you notice blur that is new or greying of vision
or loss of colour in your vision (different to the other eye), you need to
report this urgently.
5. Glaucoma.
Raised pressure in the eye,
which, if not treated, can after some years damage the vision.
Usual
Expectations
Most cases of thyroid eye disease get worse over a year or two
(or three) and then stabilise. A small number of cases can improve and a very
small number improve dramatically. It is uncertain what effect thyroid function
control has on the progress of the eye disease, but most doctors believe that it
is important to have good control with blood tests etc.
Smokers
(including passive smokers)
There is no doubt that smoking
makes thyroid eye disease worse, and interferes with the effects of any
treatment (as well as causing other health issues – if tobacco is used as
designed, it has an eventual death rate of 50%!). You should see your doctor TODAY OR
TOMORROW to start nicotine replacement (use as much as you need – be generous
with yourself) and one of the “new” pills to help you (Zyban, Champix). We can help you find a doctor if you
need.
Radioactive iodine treatment which
is necessary to control the thyroid dysfunction makes the eye disease worse in
some patients (especially those who already have eye problems).
Selenium Supplements
In Europe, taking Selenium (100 mcgms
twice daily) improves thyroid eye disease in some patients. It is not known if this will help people
living in Melbourne. I would
recommend you try it for 6 months and then decide.
Photos Are Very
Helpful
It helps me a lot to look at a
series of photos of your face. Have someone take a close up frontal shot and
also a close up of the left side and right side of your face. If there is any
change in your appearance after, say 6 or 12 months, repeat the photos. Having a
gallery of photos like this makes it easier to be accurate and precise about
what is happening to the bulginess and lid retraction of thyroid eye disease in
you.
Bring along your worst
photos (show them to me before you delete
them).
Treatment
1. Double vision.
This is initially treated with
prisms that are ground into the spectacles or stuck onto the surface of
spectacles (Fresnel prism).
If these do not work we can inject an affected muscle with a
paralyzing toxin (Botox). Botox is spectacularly successful in only about 10% of
patients, and helpful in another 20%. When it is clear that matters are stable
for some months you can have surgery on the eye muscles if prisms and/ or Botox
are inadequate or not desired. Each surgery has about a 50% success
rate.
2. Proptosis.
The best treatment for this is
surgery. Oral steroids are sometimes used whilst waiting for surgery.
3. Eyelid retraction.
Various drops are used to
help irritation. Sometimes Botox is used. Eventually when everything is stable
eyelid surgery may be required and the results are usually excellent.
4.
Optic nerve compression.
This is usually treated with
surgery though steroids can sometimes be used whilst waiting for
surgery.
5. Glaucoma.
Eye drops are used. Sometimes
surgery is performed to the eye muscles if the tightness of these muscles has
produced the glaucoma.
An excellent website is that of the
American National Graves Disease
The section ‘Graves’
Ophthalmopathy’ in Wikipedia is also very good.
A recent review can be found
at:
This information handout is
protected by the laws of Copyright and must not
be reprinted, copied or
otherwise disclosed in whole or in part to any
person without the written
consent of Dr. Lionel Kowal.
