Thyroid eye disease affects 25 – 50% of patients with Graves’ disease.
Severe thyroid eye disease is not related to the degree of thyrotoxicosis
- Risk factors
- Smoking
- Pathophysiology
- Autoimmune response to TSH receptor in the retro-orbital tissue → retro-orbital lymphocyte infiltration and proliferation of fibroblasts → glycosaminoglycan and collagen deposition in muscles
- Signs and symptoms
- Exophthalmos
- Conjunctival oedema
- Optic disc swelling
- Ophthalmoplegia
- Exposure keratopathy (due to inability to close the eyelids)
- Investigations
- Thyroid function test
- Eu-, hypo- or hypothyroidism
- Thyroid function test
- Treatment
- Topical eye lubricants
- Steroids
- Radiotherapy
- Surgery
- Prevention
- Smoking cessation
- Prednisolone to reduce the risk of eye disease in patients receiving radioiodine treatment
- Indications for ophthalmology review
- Unexplained deterioration of vision
- Awareness of change in intensity or quality of colour vision in one or both eyes
- History of eye suddenly ‘popping out’ (globe subluxation)
- Obvious corneal opacity
- The cornea is still visible when the eyelids are closed
- Disc swelling