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Thyroid Eye Disease Management

Graves’ Eye Disease Management

How do I know whether I have TED? Am I at risk of severe disease?

TED affects up to 2% of patients with Grave’s disease, the most common autoimmune disorder characterized by abnormally high levels of thyroid hormones. It can also be seen infrequently in patients with normal or low levels of thyroid hormones. Thyroid eye disease symptoms and signs include eye lid swelling and redness, eye redness, a pressure or heavy sensation behind the eyeballs, double vision and a staring appearance due to retracted eyelids and forward bulging of the eyes.

Risk factors for more severe disease include older age at onset of disease, the male gender, cigarette smoking, stress and poor control of hyperthyroidism. Undergoing radioactive iodine treatment when the TED is active is also a risk factor.

There are so many treatments available. What should I know before I decide which treatment is best for me?

The array of thyroid eye disease treatment options can be confusing as they must be customized to the patient’s particular situation. No two patients undergo exactly the same treatment. When seeing the oculoplastic surgeon graves opthalmopathy, it is crucial to have the eyes fully assessed to determine how active and how severe the disease is. TED has an active phase that can last up to 18 months. During the active phase, medical immunosuppression and radiotherapy are helpful in inducing quiescence.

Non-drug measures such as avoidance of smoking and stress are useful adjuncts. Surgery during the active phase is reserved only for emergency circumstances when vision is affected by marked swelling of the eye muscles and fat surrounding the eyeballs. More frequently, surgery is reserved for the later inactive phase of the disease. Surgery is usually staged with orbital decompression being performed first where necessary, followed by squint surgery where required and finally, eyelid surgery. The journey can be tiring and family support, together with expert medical guidance, is invaluable in optimizing outcomes.