Thyroid eye disease, also known as TED, is an orbital disease closely linked to Hashimoto’s thyroiditis, Graves’ disease, and other immune disorders affecting the thyroid. Although the condition affects all races and ages, it most often occurs in individuals in their 20s to 60s. Women are far more likely to develop TED than men. TED affects approximately 14 out of every 100,000 females. The incidence among males is roughly one-fifth that of females.
Approximately 25 to 50 percent of individuals with an immune disease of the thyroid develop TED that involves the orbit of the eye. This thyroid orbitopathy can lead to optic neuropathy, impaired motility, congestion, and severe inflammation. Although an estimated 90 percent of patients with orbitopathy have a history of thyroid hormone abnormalities, the condition is not caused by the abnormal hormone levels, and the orbital disease does not automatically resolve once hormone levels are normalized.
Patients with thyroid eye disease typically experience an active disease phase in which the inflammatory symptoms are progressive. This is followed by a post-inflammatory phase in which the symptoms stabilize and become inactive. The active phase of the disease can last up to 18 months. During this time, the patient may experience symptoms that include:
orbital pain and discomfort,
swelling and redness around the eye and conjunctiva,
abnormal protrusion of the eye,
strabismus, and
optic neuropathy.
A small number of patients with thyroid dysfunction and severe orbitopathy go on to develop a skin condition known as Graves’ dermopathy in which the skin of the lower limbs becomes red and swollen and develops an orange peel-like texture. Some of these patients also go on to develop a thickening or clubbing of the nail beds and fingertips.
Once the condition becomes dormant, the patient can consult an oculoplastic surgeon like Dr. Robert Schwarcz to correct the damage caused by the active phase of the disease. This typically involves surgery to realign the eye muscles, reduce pockets of fat in the eyelids, narrow the opening of the eyelid, and lessen the protrusion of the eye. Click here to learn more about thyroid orbitopathy.
