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What Is Thyroid Eye Disease, And When Does It Require Surgery?

Thyroid eye disease (TED), also known as Graves’ eye disease, usually stems from an autoimmune condition that starts when immune cells attack the thyroid gland, a tiny butterfly-shaped gland at the front of the neck.

Usually, the thyroid goes unnoticed, doing its job manufacturing the hormones that regulate the body’s metabolism. But when immune cells invade, the tiny gland responds by enlarging and secreting an excess amount of thyroid hormone. This results in increased metabolism, causing symptoms such as a fast heartbeat, high blood pressure, palpitations, heavy sweating, irritability, fatigue, and weight and hair loss.

“When the thyroid goes into overdrive, the immune system may also attack the tissues around the eyes,” explains Robert Kersten, MD, chief of the John A. Moran Eye Center’s Oculoplastic Division and part of University of Utah Health’s Thyroid Eye Disease (UTED) program.

Thyroid Eye Disease Symptoms

TED symptoms can vary, and they may come and go, but Kersten lists these as a few of the most common:

  • Eyelid retraction: This happens when muscles surrounding the eye swell and push the eye forward, pulling the upper and lower eyelids back.
  • Eye protrusion: Swelling may push the eye forward and make the patient look like they are staring.
  • Dry eye: When the eyes retract or protrude, they’re exposed to dust and wind. This can cause dryness and an uncomfortable, scratchy feeling. It may also cause blurry vision and light sensitivity.
  • Vision changes: Swelling around the eye may cause double vision. It can also put pressure on the optic nerve, which connects the eye to the brain.
  • Eye “bags”: Swelling can cause the tissue around the eye to bulge, commonly called “bags” around the eyes.

How Is Thyroid Eye Disease Treated?

“Fortunately, we can treat all of these symptoms, and some new drugs are helping to make a real difference for some patients,” Kersten says. “But the treatments can vary as much as the symptoms. Because TED diagnoses and symptoms tend toward the complex, patients need to work closely with their ophthalmologists and thyroid specialists to find the best customized treatments.”

Graves Orbitopathy

“About half of the patients with Graves eye disease will develop a disease called Graves’ orbitopathy, an eye socket disorder,” Kersten says. “And some of this group will require surgery.”

Because the eye socket stays the same, the enlarged eye muscles may not move properly. This can cause double vision. Increased pressure in the eye socket can also damage the optic nerve, causing loss of eyesight.

At this point, a surgery called endonasal endoscopic orbital decompression, done through the nose without external incisions through the skin, is often the solution to relieve the pressure.

Kersten works with UTED to take a team approach in customizing each case and consulting with the university’s fellowship-trained physicians in endocrinology, sinus and skull base surgery, oculoplastics, and neuro-ophthalmology. Many TED patients need a team with both medical and surgical expertise.