Thyroid Eye Disease (Graves' Ophthalmopathy)
This disease is also called thyroid eye disease. In this disease, there is an increase in fatty tissue behind the eye, swelling and hardening of the eye muscles (fibrosis) and swelling of the soft tissues around the eye. The presentation of the disease varies from person to person. In some patients, eye symptoms appear shortly after the T4 and T3 hormones in the blood increase, while in others, very minor changes are observed for many years.
Relationship between Eye Symptoms and Thyroid Disease
Graves' ophthalmopathy occurs with or at the same time as the onset of hyperthyroidism (elevated thyroid hormones) in % 40 patients, while in % 40 patients it occurs some time after the onset of hyperthyroidism. In % 20 patients, enlargement of the eyes (ophthalmopathy) occurs first and then hyperthyroidism develops. There may be people with eye symptoms even though their thyroid hormones have been and are still normal. This disease is called '' It is called "euthyroid Graves' ophthalmopathy". This means that although thyroid hormones are normal, eye enlargement due to occult thyroid disease is rare (this type of disease accounts for % 3 of all cases of ophthalmopathy).
Course of Eye Findings
- Eye symptoms occur in both eyes in 85-95 patients with % and in one eye in 5-15 patients with %.
- Eye symptoms are severe in 3-5 patients with % and the disease is severe, but most patients have a very good prognosis and benefit from treatment.
- Ophthalmopathy is more common in women (female to male ratio of 1.8-2.8/1) and more severe in older people and men.
Other Eye Findings
- Pain in the eye when looking up, down or sideways.
- Dry eyes, itching, dryness and difficulty wearing contact lenses.
- Inflammation and swelling in the eye and surrounding tissues
- Bloodshot eyes
- Sometimes double vision
- Visual impairment
Diagnosis and Differential Diagnosis
When ophthalmopathy is present in both eyes, the diagnosis is not a problem. However, if it occurs in one eye, other causes must be ruled out. In these patients, thyroid hormone tests are first performed to investigate whether they have Graves' disease. Then a tomography or MRI scan of the eye is performed. Thus, it is investigated whether there are diseases such as tumors, axial myopia, other inflammatory diseases, cysts, ballooning of blood vessels called aneurysms and a type of cancer called lymphoma that may cause these symptoms. A complete blood test is performed to check for blood disorders.
Factors Causing Worsening or Increased Severity of Graves' Ophthalmopathy
- Severe and long-lasting overwork of the thyroid gland (hyperthyroidism),
- Thyroid gland failure (hypothyroidism) as a result of an overdose of Propylthiouracil or Methimazole (elevated TSH),
- Smoking
- Very high levels of TSH-receptor antibodies
Measurement of the Degree of Eye Forward Protrusion
In ophthalmopathy, the upper eyelids contract or retract. The eye socket bulges forward, which is called exophthalmos or proptosis. Proptosis, i.e. the degree of protrusion of the eye, can be measured by an ophthalmologist with a Hertel exophthalmometer, or more precisely with an eye tomography or MRI. The amount of eye protrusion varies according to each race. In Turks, protrusion of the eye over 21 mm is abnormal. The reason why the eye protrudes forward is due to the increase in fat and mucopolysaccharide tissue behind the eyeball and swelling of the eye muscles due to inflammation.
Graves' Ophthalmopathy Stages
There are 2 stages or periods of ophthalmopathy:
- Initial onset or inflammatory period or active phase (lasts 3-9 months)
- Period of hardening of tissues (Fibrotic phase)
How is Eye Disease Treated?
There are 3 stages of treatment for Graves' ophthalmopathy:
- Treatment of hyperthyroidism, i.e. high T3 and T4 hormones
- Complaint-oriented treatment
- Treatment of ophthalmopathy (medication, prismatic glasses, cortisone therapy, strabismus or decompression surgery)
