Introduction
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
- 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
- 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
- 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
- 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