Thyroid Eye Disease: The Overlooked Impact of Thyroid Disorders

Thyroid disorders are common endocrine conditions that affect millions of people worldwide. These disorders, which include hypothyroidism and hyperthyroidism, arise due to imbalances in the thyroid gland's hormone production. While the physical and metabolic consequences of thyroid dysfunction are widely known, one aspect that is often overlooked is the potential impact on the eyes. Thyroid Eye Disease (TED), also known as Graves' ophthalmopathy, is a debilitating condition that affects the eyes of individuals with thyroid disorders. In this blog, we will delve into the scientific research surrounding TED and its connection to thyroid disorders, explore the reasons behind the occurrence of TED, and highlight potential prevention and management strategies.

The Connection between Thyroid Disorders and Thyroid Eye Disease

Thyroid disorders result from the thyroid gland's improper functioning, leading to either an overproduction or underproduction of thyroid hormones. These hormones play a vital role in regulating metabolism and overall bodily functions. However, in some cases, the immune system may attack the thyroid gland, causing it to produce excessive amounts of thyroid hormones, leading to hyperthyroidism, or in rare cases, reducing hormone production, causing hypothyroidism.

Thyroid Eye Disease is commonly associated with hyperthyroidism, particularly in individuals with Graves' disease, an autoimmune disorder. Graves' disease stimulates the production of autoantibodies, specifically thyroid-stimulating immunoglobulins (TSIs), that mimic the actions of thyroid-stimulating hormone (TSH). These TSIs bind to the TSH receptors in the thyroid gland and ocular tissues, resulting in an overactive thyroid gland and inflammation in the orbital tissues around the eyes.

The Mechanisms Behind Thyroid Eye Disease

The exact mechanisms triggering TED are not fully understood, but scientific research has provided valuable insights. The orbital tissues around the eyes contain cells with TSH receptors. When TSIs bind to these receptors, they stimulate the release of cytokines and other inflammatory mediators, leading to the accumulation of immune cells in the eye tissues. This immune response causes swelling and inflammation of the orbital tissues, leading to various ocular manifestations.

Inflammation of the eye muscles can result in protrusion of the eyeballs, known as proptosis, and restrict eye movements, leading to double vision or diplopia. Additionally, inflammation of the orbital fat can lead to swelling and further push the eyes forward. Furthermore, TED may cause retraction of the eyelids, exposing more of the eye's surface, and can even affect the tissues around the optic nerve, potentially leading to vision loss.

How to Prevent and Manage Thyroid Eye Disease

Preventive Measures:

• Effective management of underlying thyroid disorders is crucial to reduce the risk of developing TED.
• Regular thyroid function tests and close monitoring of hormone levels can aid in early detection and intervention.

Management Strategies:

For Graves' disease (hyperthyroidism) management:

• Antithyroid medications (methimazole and propylthiouracil) can be prescribed to inhibit excessive hormone production.
• Radioactive iodine therapy can be considered to control hyperthyroidism.
• Surgical removal of the thyroid gland (thyroidectomy) is an option in some cases.

For managing TED symptoms and inflammation:

• Glucocorticoids can be administered either orally or intravenously to control inflammation and alleviate eye-related discomfort.
• Immunosuppressive therapy may be used to dampen the immune response contributing to TED.

Surgical Interventions for severe cases of TED:

• Orbital decompression surgery can create more space in the eye socket and reduce pressure on the optic nerve.
• Strabismus surgery can correct double vision caused by misaligned eye muscles.
• Eyelid surgery can address retracted eyelids and improve eye closure.

SUMMARY

Thyroid Eye Disease is a significant yet often overlooked complication of thyroid disorders, especially hyperthyroidism associated with Graves' disease. The condition arises due to the immune system's attack on the orbital tissues surrounding the eyes, leading to inflammation and various ocular manifestations. Early detection and effective management of underlying thyroid disorders are crucial to prevent or minimize the impact of TED. Through antithyroid medications, radioiodine therapy, and surgical interventions, both thyroid disorders and TED can be managed, enabling individuals to lead healthier and more comfortable lives.

Jayti Shah is a Clinical Nutritionist with a master's degree in Clinical Nutrition and Dietetics. She is a member of the Indian Dietetic Association (IDA). Over the last 9 years, she has helped 400 clients in their clinical and weight loss journeys. She works with SocialBoat as a nutrition consultant.

At SocialBoat, we offer custom diet plans and guided workouts to help you achieve your goals in a 360-degree approach. Our gamified experience ensures that you don’t find workouts boring and we reward you for being consistent with your efforts.

REFERENCES

1. Bartalena, L. et al. (2020). The 2020 European Group on Graves' Orbitopathy (EUGOGO) Clinical Practice Guidelines for the Management of Graves' Orbitopathy. European Thyroid Journal, 9(2), 55-85.
2. Khoo, D. H. et al. (2019). Thyroid eye disease: current and future treatment options. Therapeutic Advances in Endocrinology and Metabolism, 10, 2042018819896143.
3. Ross, D. S. (2019). Graves’ Orbitopathy: Genes, Autoimmunity, and Therapy. Journal of Clinical Endocrinology & Metabolism, 104(2), 468-475.
4. Stan, M. N. (2019). Biologics in Graves' orbitopathy. Best Practice & Research Clinical Endocrinology & Metabolism, 33(5), 101323.
5. Wiersinga, W. M. (2018). Advances in treatment of active, moderate-to-severe Graves' ophthalmopathy. The Lancet Diabetes & Endocrinology, 6(4), 287-299.