More about Graves’ Disease (Thyroid)

Thyroid eye disease (TED) occurs in around 40 percent of people with Graves’ disease, an autoimmune disorder.

Graves’ disease is an autoimmune disorder that causes your thyroid gland to produce more hormones than it should. Overactive thyroid is called hyperthyroidism. Among the potential symptoms of Graves’ disease are irregular heartbeat, weight loss, and an enlarged thyroid gland (goiter). Sometimes, the immune system attacks tissues and muscles around the eyes. This is a condition called thyroid eye disease or Graves’ ophthalmopathy (GO). Inflammation causes the eyes to feel gritty, dry, and irritated. This condition can also make your eyes appear to bulge out. Graves’ eye disease affects between 25 and 50 percent of people who have Graves’ disease.Trusted Source It can also occur in people who don’t have Graves’ disease.

In hyperthyroidism, the thyroid gland is overactive. It produces too much of its hormone. Hyperthyroidism affects about 1 percent of women. It’s less common in men.

Graves’ disease is the most common cause of hyperthyroidism, affecting about 70 percent of people with an overactive thyroid. Nodules on the thyroid — a condition called toxic nodular goiter or multinodular goiter — can also cause the gland to overproduce its hormones. Excessive thyroid hormone production leads to symptoms such as: Restlessness; Nervousness; Racing heart; Irritability; Increased sweating; Shaking and Anxiety. A blood test measures levels of thyroid hormone (thyroxine, or T4) and thyroid-stimulating hormone (TSH) in your blood. The pituitary gland releases TSH to stimulate the thyroid to produce its hormones. High thyroxine and low TSH levels indicate that your thyroid gland is overactive. Your doctor might also give you radioactive iodine by mouth or as an injection, and then measure how much of it your thyroid gland takes up. Your thyroid takes in iodine to produce its hormones. Taking in a lot of radioactive iodine is a sign that your thyroid is overactive. The low level of radioactivity resolves quickly and isn’t dangerous for most people.

Graves’ disease was named for the doctor who first described it more than 150 years ago. It’s the most common cause of hyperthyroidism in the United States, affecting about 1 in 200 people. Graves’ is an autoimmune disorder that occurs when the body’s immune system mistakenly attacks the thyroid gland. This can cause the gland to overproduce the hormone responsible for regulating metabolism. The disease is hereditary and may develop at any age in men or women, but it’s much more common in women ages 20 to 30, according to the Department of Health and Human ServicesTrusted Source. Other risk factors include stress, pregnancy, and smoking. When there’s a high level of thyroid hormone in your bloodstream, your body’s systems speed up and cause symptoms that are common to hyperthyroidism. A simple physical exam can reveal an enlarged thyroid, enlarged bulging eyes, and signs of increased metabolism, including rapid pulse and high blood pressure. Your doctor will also order blood tests to check for high levels of T4 and low levels of TSH, both of which are signs of Graves’ disease. A radioactive iodine uptake test might also be administered to measure how quickly your thyroid takes up iodine. A high uptake of iodine is consistent with Graves’ disease.

Causes

The exact cause isn’t clear, but it may be a combination of genetic and environmental factors. The inflammation around the eye is due to an autoimmune response. The symptoms are due to swelling around the eye and retraction of the eyelids. Graves’ eye disease usually occurs in conjunction with hyperthyroidism, but not always. It can occur when your thyroid isn’t currently overactive. Risk factors for GO include: Genetic influences, Smoking, Iodine therapy for hyperthyroidism. You can develop Graves’ disease at any age, but most people are between the ages of 30 and 60 at diagnosis. Graves’ disease affects about 3 percent of women and 0.5 percent of men

Symptoms

Common symptoms include eye irritation, inflammation, and redness. In more severe cases, people experience bulging, retraction of the eyelids, and pressure on the optic nerve. Most of the time, Graves’ eye disease affects both eyes. About 15 percent of the time, only one eye is involved.Trusted Source There’s no connection between your eye symptoms and the severity of your hyperthyroidism. Symptoms of GO may include: Dry eyes, grittiness, irritation; Eye pressure and pain; Redness and inflammation; Retracting eyelids; Bulging of the eyes, also called proptosis or exophthalmos; Light sensitivity; Double vision. In severe cases, you might have trouble moving or closing your eyes, ulceration of the cornea, and compression of the optic nerve. GO can lead to loss of vision, but this is rare. Symptoms generally start around the same time as other symptoms of Graves’ disease, but some people develop eye symptoms first. Rarely does GO develop long after treatment for Graves’ disease. It’s also possible to develop GO without having hyperthyroidism.

Treatments

Iodine!

Some treatments address the TED itself, while others treat the underlying Graves’ disease. Home Remedies – During the active phase of TED, home care may help relieve your symptoms. These include: Eye drops to lubricate the eye; Cool compresses; Wearing sunglasses for light sensitivity; Wearing glasses with a prism for double vision (your eye specialist may recommend this). IV infusions – Teprotumumab-trbw (Tepezza) is an antibody medication developed to relieve swelling in cases of TED. It eases the pressure on your optic nerve and reduces bulging of the eyes. Teprotumumab-trbw is an infused medication. This means it’s delivered through an intravenous (IV) needle in your arm. Treatment involves eight IV infusions. Each infusion will be 3 weeks apart. Many people will notice symptom improvement in about 6 weeks. It’s important to get all of the required infusions to receive the full dose of the medication. As with any medication, there can be side effects. Antithyroid Drugs – Graves’ disease is an autoimmune disease that attacks the thyroid. When under attack, your thyroid releases too much thyroid hormone. This is called hyperthyroidism. Antithyroid drugs stop your thyroid from producing hormones. The goal is to bring thyroid levels to a healthy target. Although TED often occurs with Graves’ disease, they are separate conditions. TED can still occur with low or normal thyroid levels. The conditions will run their own courses. If your thyroid levels are too high or low, your healthcare provider will closely monitor your blood levels. This helps them determine whether treatment is working or needs to be adjusted. Other treatments: Synthetic hormones – When the thyroid is removed levels can drop too low, according to 2016 guidelines by the American Thyroid Association (ATA) and you will be started on synthetic thyroid hormone. In the case of low thyroid levels due to antithyroid drugs, your doctor will reduce your dose of the medication. Selenium supplements – Trusted SourceClinical trials have found that taking selenium can reduce the toll TED takes on your cells. Selenium is an antioxidant taken as an oral supplement. Your doctor can advise you on whether selenium might help your condition. Botulinum toxin A – Your healthcare provider may suggest injecting botulinum toxin A (BTA) into your eye muscles to treat strabismus. This is when your eyes don’t correctly align with each other when you look at an object. BTA can also be injected into the eyelid to improve its shape and position. Radioiodine – While radioiodine has been used in treating Graves’ disease, a body of evidence has shown that it can worsen thyroid eye disease. According to the ATA guidelines, surgery or antithyroid medications are best in cases of moderate to severe TED. Radiation therapy should be avoided, especially in people who are pregnant and those who smoke. Surgeries