On the latest episode of the EYE-Q Podcast, Dr. Rudrani Banik explores Thyroid Eye Disease (TED). This multifaceted condition affects the eyes and is closely linked to thyroid dysfunction. As eye care professionals, understanding TED’s pathophysiology, symptoms, and treatment options is essential to providing optimal care to affected patients. TED is an autoimmune disorder where inflammation affects the tissues around the eyes, leading to changes in the eye socket and surrounding structures. In this article, we’ll explore the connection between the thyroid and the eyes, symptoms, risk factors, diagnostic approaches, and treatment options for TED.

Thyroid Eye Disease, also known as Graves’ Orbitopathy or Thyroid-Associated Orbitopathy (TAO), is an autoimmune condition primarily linked to hyperthyroidism, particularly Graves’ disease. TED occurs when the immune system mistakenly targets the muscles and fat tissue behind the eyes. This results in inflammation and swelling, causing the eyes to protrude, a condition known as proptosis, and other associated symptoms. Dr. Rudrani Banik explains, “These two organs that you would normally not associate with each other can be connected when there’s an autoimmune condition known as thyroid eye disease.”

The thyroid and the eyes are connected through the muscles and fat tissue in the eye socket. Both the muscles behind the eyes and the fat pads within the eye socket have receptors that are similar to those found on the thyroid gland. When the thyroid is involved in an autoimmune process, the antibodies targeting the thyroid can cross-react with these receptors in the eye socket, leading to inflammation and swelling. Dr. Banik further elaborates, “The thyroid eye connection is via the contents within the eye socket, including both the muscles behind the eyes that move the eyes and the fat pads that cushion the eye socket.”

The symptoms of thyroid eye disease can vary in severity but typically include dry, gritty eyes, swollen eyelids, and the wide-eyed appearance often associated with the condition. As the inflammation worsens, patients may experience more significant symptoms like proptosis, double vision, and, in extreme cases, vision loss due to optic nerve compression. Dr. Banik notes, “Some patients may actually feel like their eyes are bulging forward… and in the worst of cases, they may be at risk for vision loss.”

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• Autoimmune hyperthyroidism (Graves’ disease) – Most common underlying condition for TED
  
  
• Normal thyroid function – TED can occur in individuals with normal thyroid function
  
  
• Gender – More common in females, with an 8:1 female-to-male ratio
  
  
• Age – Typically affects adults aged 40 to 70
  
  
• Modifiable risk factors:
  
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  • Smoking – Exposure to cigarette smoke, whether primary or secondary
    
    
  • Selenium deficiency – Can contribute to TED development
    
    
  • Vitamin D deficiency – Linked to increased risk
    
    
  • Stress – Can trigger or worsen the condition
    
  
  
  

Diagnosis of TED typically begins with a basic thyroid panel, including tests for TSH (Thyroid Stimulating Hormone), free T4, and free T3. If autoimmune thyroid disease is suspected, more advanced tests such as thyroid peroxidase antibody (anti-TPO), thyroglobulin antibody (anti-TG), and thyroid stimulating immunoglobulin (TSI) should be ordered. Dr. Banik emphasizes the importance of a comprehensive approach to diagnosis, stating, “You need to order the autoimmune panel if you suspect something’s going on with the thyroid. Regular thyroid tests are not going to pick up autoimmune issues.”

While treatment for thyroid eye disease can range from conservative management to surgical intervention, the goal is to reduce inflammation and manage symptoms effectively. Corticosteroids are commonly used to control inflammation, and in severe cases, surgical interventions may be required to correct the position of the eyelids or relieve pressure on the optic nerve. In some cases, patients may be referred for radioactive iodine ablation to treat underlying thyroid issues, though this can sometimes exacerbate TED. Dr. Banik notes, “We now have a lot of things in our armamentarium of treatment approaches,” highlighting the advancements in managing TED.

Find more of The EYE-Q Podcast here.