Thyroid Eye Disease

Eye Health

By Dr S.S. Gill

Ipoh Echo’s EYE HEALTH series continues with Consultant Eye Surgeon Dr S.S. GILL talking to us about Thyroid Eye Disease.

The Thyroid gland is an organ that is found in the front of the neck. Thyroid hormones are released by the thyroid gland into the bloodstream as “chemical messengers” which are essential for managing the metabolism in our bodies. As with most organs in the body, when the thyroid gland functions well, it goes unnoticed but when it starts producing too much or too little hormones, it causes a lot of problems to the body. The eyes get affected when the gland becomes hyperactive. When this happens, it is termed as either Thyroid Eye Disease or Thyroid Orbitopathy, Graves’ Ophthalmopathy, Ophthalmic Graves’ Disease or Thyroid Ophthalmopathy.

Who Gets Thyroid Eye Disease?

Thankfully this is not a very common condition. In every 100,000 people, approximately 15 women and 3 men are affected by Thyroid Eye Disease. Most of the time it affects the middle age group. There is a genetic link, making those in some families to be more predisposed to suffering from Thyroid Eye Disease.

What Happens To The Eyes In Thyroid Disease?

• In Thyroid Eye Disease, the eye muscles and fat that surrounds the eyeball gets inflamed (swollen). The two eyeballs may or may not be affected equally, giving rise to the following symptoms in the eyes:
• Eyes protrude or bulge out of its sockets – an appearance that the person is staring! Thyroid Eye disease is the most common cause of protruding eyes (proptosis).
• More of the cornea (transparent part of the eye) and the conjunctiva (white of the eye) get exposed because the eyelids may not fully close over the eyes well enough (eyelid retraction).
• The eyes may ache, with intermittent sharp pain when the cornea dries out especially   when the person is concentrating on something for long as in reading.
• Some people get diplopia (double vision) because the eye muscles are unable to move properly due to the swelling of the eye muscles.
• Blurring vision in some patients.

This may happen along with other features such as irritability or nervousness (mood disturbances), preference for cold environments, increased sweating, insomnia (sleeping difficulty), palpitations (a rapid heartbeat), tremor of the hands, weight loss, frequent bowel movements, unexplained fatigue or weakness of muscle, difficulty in conception and irregular menstruation.

How Is It Diagnosed?

If a doctor suspects that you may be having Thyroid Eye Disease, the following tests are usually done:

• Thyroid Function Test (blood test): This will measure hormone levels in your body which includes TSH (Thyroid Stimulating Hormone), T4 which is the principal thyroid hormone and another thyroid hormone T3, plus Thyroid Stimulating Immunoglobulin Test (TSI). The other blood test that may be done is the RAIU test             (Radioactive Iodine Uptake) – which helps to evaluate the Thyroid gland and to find out the cause of increased production of thyroid hormones (hyperthyroidism).
• Thyroid Scan – to determine the shape and size of the thyroid gland and to pick up any thyroid nodules that may be benign or cancerous.
• MRI Scan of the Orbits – to determine the amount of proptosis (bulging forward of eyes) and the amount of inflammation of the eye muscles within the eyeball sockets.

More on Thyroid Eye Disease prognosis and treatment in the next issue.