Dysthyroid eye disease


Dysthyroid eye disease

Description, Causes and Risk Factors:

The thyroid is a small, butterfly-shaped gland in the front of the neck below the larynx, or voice box. The thyroid gland makes two thyroid hormones, triiodothyronine (T3) and thyroxine (T4). Thyroid hormones affect metabolism, brain development, breathing, heart and nervous system functions, body temperature, muscle strength, skin dryness, menstrual cycles, weight, and cholesterol levels. Thyroid hormone production is regulated by another hormone called thyroid-stimulating hormone (TSH), which is made by the pituitary gland located in the brain.

Dysthyroid eye disease

Dysthyroid eye disease also known as Graves' ophthalmopathy or thyroid-associated ophthalmopathy, is the most frequent extrathyroidal manifestation of autoimmune hyperthyroidism (Graves' disease); 25-50% of patients with Graves' disease have eye involvement, of whom 3-5% develop severe disease.

The etiology of is complex. Genetic susceptibility and endogenous and environmental factors play a role in its development. The genetic factors are poorly defined but appear to have the lesser role. The risk of developing dysthyroid eye disease increases with age and women are more likely to develop Graves disease than men.

Most people with dysthyroid eye disease have or had or will subsequently develop an overactive thyroid gland.

Overactivity of the thyroid gland is usually caused by an "autoimmune condition." This means that cells which normally protect the body from infection develop a "fault" and begin to recognize the thyroid gland as foreign material and attack it. This stimulates the thyroid gland to produce extra thyroid hormones. The attacking process may spill over to the cells behind the eye causing them to swell. It is not yet known why cells develop the fault that causes them to attack the thyroid gland or why only some patients with overactivity of the thyroid develop dysthyroid eye disease. Dysthyroid eye disease does appear to be more common in smokers.

Symptoms:

Symptoms may include:

    The eyes have a gritty sensation and are sore, irritated, red and watery.

  • The eyelids and tissue around the eyes become puffy because of fluid retention, which is usually worse after sleeping.

  • Exophthalmos (protrusion of the eyeball from the socket).

  • Diplopia (double vision).

  • Conjunctivitis (inflammation of the inner eyelids).

  • Diminished visual acuity (blurry or distorted vision).

  • Photophobia (sensitivity to light).

  • Excessive tearing.

Diagnosis:

Diagnosis is usually made on the basis of the patient's clinical signs and symptoms. However, further tests are clinically useful for determining the type and extent of orbital involvement. The enlarged extraocular muscles can be detected by A-scan or B-scan ultrasonography, or by a CT (computerized tomography) scan. CT scan is especially important when proptosis is not obvious since there is a tendency for apical muscle enlargement in some cases, which can produce compression of the optic nerve. It is also mandatory that patients exhibiting dysthyroid eye disease also be examined and assessed for thyroid disease.

Blood tests: Sometimes, blood tests are needed to back up the diagnosis. They look at how well the thyroid gland is functioning by measuring its hormones (chemical messengers) in your bloodstream. These are called thyroid function tests (TFTs). More specialized blood tests can be done to measure the antibodies in your blood.

Treatment:

Its treatment, despite recent developments, is still challenging, and complete improvement of functional and/or cosmetic impairment is not always possible.

Mild-to-moderate cases of dysthyroid eye disease usually resolve within a few months to two years without specific eye treatment. Patients can use artificial tears to soothe irritated eyes, and if double vision occurs, special glasses with prism lenses can help. Unfortunately, the double vision may not resolve completely, and many patients continue to have bulging eyes even after other symptoms disappear.

In patients whose eye disease progresses even after thyroid treatment, the doctor may prescribe corticosteroids to reduce swelling and inflammation around the eyes. Immunosuppressant drugs also are a possibility, or a combination of the two.

Surgery is an option for improving the appearance of the eyes. The function and appearance of the eyes can usually be improved by reconstructive eyelid or orbital surgery. Surgical treatment is generally delayed until the active inflammation subsides. The particular surgical technique used will depend on the type and severity of the eye problems.

Risks and benefits of the surgery should be discussed with your surgeon.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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