Thyroid Eye Disease (TED), also referred to as Graves' orbitopathy or thyroid-associated ophthalmopathy, is a serious condition that arises when the immune system mistakenly attacks the tissues around the eyes, leading to inflammation and various symptoms. These symptoms can range from mild irritation to severe complications like visual impairment or changes in the appearance of the eyes.

Common Signs and Symptoms of Thyroid Eye Disease (TED)

TED can manifest in a wide range of symptoms, from minor irritation to more serious changes that impact vision. Here are the most common signs to look for:

Protruding Eyes (Exophthalmos): One of the key symptoms of TED, exophthalmos, occurs when the eyes bulge outward due to swelling and inflammation in the tissues around the eye socket. This symptom typically develops slowly and may go unnoticed at first.

Dryness and Irritation: Many individuals with TED experience dryness, redness, and discomfort, resembling symptoms of common dry eye conditions. However, typical over-the-counter treatments offer only limited relief.

Eyelid Swelling or Retraction: Swelling or retraction of the eyelids is common in TED, making the eyes appear "stiff." This can be confused with other conditions like allergies or conjunctivitis.

Double Vision (Diplopia): Swelling of the muscles behind the eyes can lead to double vision, particularly when looking in certain directions. If left untreated, this symptom may worsen over time.

Eye Pressure or Pain: A constant feeling of pressure, discomfort, or pain around the eyes is common, particularly when moving the eyes or straining.

Light Sensitivity (Photophobia): Inflammation in the eyes can make them more sensitive to light, often mistaken for migraine or other conditions.

Difficulty Moving the Eyes: When the muscles around the eyes become swollen and stiff, it can lead to reduced eye movement or restrictive myopathy. This can make it difficult for patients to look in certain directions without discomfort or double vision.

The severity of these symptoms can vary, and some may develop gradually or subtly, making TED progress differently for each individual. If these symptoms persist, it’s important to consult with an ophthalmologist.

TED May Be More Common Than You Think

Though TED might seem rare, it is actually relatively common among those with thyroid diseases. Studies show that about 50% of people with thyroid disease also experience TED. In the general U.S. population, the annual incidence is approximately 16 cases per 100,000 women and 2.9 cases per 100,000 men (Source: National Library of Medicine).

TED tends to have a bimodal peak in incidence, with women experiencing peaks between 40-44 and 60-64 years of age, while men see peak incidences between 45-49 and 65-69 years of age. Older individuals are more likely to develop more severe cases, including an increased risk of restrictive myopathy and dysthyroid optic neuropathy (DON) (Source: National Library of Medicine).

Environmental Factors: Smoking is strongly linked to TED and can exacerbate symptoms, as well as increase the risk of developing the disease. Addressing environmental factors, such as quitting smoking, can reduce the risk of TED and improve overall outcomes.

Treatment Options for TED

The treatment for TED depends on the severity of the symptoms. One of the most effective options is Tepezza (teprotumumab), a medication specifically developed for TED. Tepezza targets the proteins responsible for inflammation and swelling in the eye area, reducing symptoms like bulging eyes and double vision, and significantly improving both appearance and vision (Source: Tepezza).

For milder cases, lubricating eye drops or wearing sunglasses can help alleviate dryness and light sensitivity. In severe cases, surgical procedures like orbital decompression may be necessary to protect vision (Source: Thyroid Eyes).

Final Thoughts

Recognizing the symptoms of TED early is crucial for early intervention, which can potentially halt the progression of the disease. Awareness of TED's prevalence and risk factors enables affected individuals to seek specialized care in a timely manner. If you or someone you know is experiencing persistent eye symptoms or has a history of thyroid disease, seeing an ophthalmologist for further evaluation is strongly recommended.