Introduction
Thyroid eye disease affects between 25-50% of patients with Graves' disease.
Epidemiology
- Incidence: 10.00 cases per 100,000 person-years
- Peak incidence: 30-40 years
- Sex ratio: more common in females 6:1
| <1 | 1-5 | 6+ | 16+ | 30+ | 40+ | 50+ | 60+ | 70+ | 80+ |
Aetiology
Prevention
- smoking is the most important modifiable risk factor for the development of thyroid eye disease
- radioiodine treatment may increase the inflammatory symptoms seen in thyroid eye disease. In a recent study of patients with Graves' disease around 15% developed, or had worsening of, eye disease. Prednisolone may help reduce the risk
Pathophysiology
Pathophysiology
- it is thought to be caused by an autoimmune response against an autoantigen, possibly the TSH receptor → retro-orbital inflammation
- the inflammation results in glycosaminoglycan and collagen deposition in the muscles
Clinical features
Features
- the patient may be eu-, hypo- or hyperthyroid at the time of presentation
- exophthalmos
- conjunctival oedema
- optic disc swelling
- ophthalmoplegia
- inability to close the eyelids may lead to sore, dry eyes. If severe and untreated patients can be at risk of exposure keratopathy
Management
Management
For patients with established thyroid eye disease the following symptoms/signs should indicate the need for urgent review by an ophthalmologist (see EUGOGO guidelines):
- topical lubricants may be needed to help prevent corneal inflammation caused by exposure
- steroids
- radiotherapy
- surgery
Monitoring patients with established thyroid eye disease
For patients with established thyroid eye disease the following symptoms/signs should indicate the need for urgent review by an ophthalmologist (see EUGOGO guidelines):
- unexplained deterioration in vision
- awareness of change in intensity or quality of colour vision in one or both eyes
- history of eye suddenly 'popping out' (globe subluxation)
- obvious corneal opacity
- cornea still visible when the eyelids are closed
- disc swelling