Thyroid Eye Disease
Thyroid Eye Disease (TED) is an autoimmune disorder that causes inflammation around the eyes and tissues behind the eyes. This inflammation causes the muscles and fat behind the eyes to expand and push the eye forward. As Thyroid Eye Disease progresses, people can experience bulgy eyes, orbital pain, redness, double vision, headaches, vision loss, tearing, and even blindness. Dr. Jennifer Murdock is the leading TED expert in South Florida and the Miami area and carries her expertise to provide advanced education in Thyroid Eye Disease across the world.
How did I get Thyroid Eye Disease?
Sometimes these things just happen. Thyroid Eye Disease is an autoimmune disorder, which happens when your immune system gets abnormally triggered by an illness, virus, surgery, or any other trigger that causes inflammation. Genetics also play a role as 10% of people who have Thyroid Eye Disease also have a family member with the same disease. Essentially, your own body’s immune system attacks itself. In Thyroid Eye Disease, the immune system attacks the orbital tissues, extraocular muscles, and tissues around the eyes. The goal of treatment is to improve inflammation and keep the autoimmune status in “remission”.
Isn’t Thyroid Eye Disease the same as Graves’ Disease (GD)?
Not at all. However, both diseases can be related to each other and co-exist in many patients. While Thyroid Eye Disease is an autoimmune disorder that affects the tissues around the eyes, Graves’ Disease affects the tissues of the thyroid. For decades, us Thyroid Eye Disease experts (endocrinologists, neuro-ophthalmologists, and oculoplastic surgeons) have had a misunderstanding of these two distinct but related autoimmune disorders. Most people with Thyroid Eye Disease also have autoimmune disease that affects the thyroid, Graves’ Disease hyperthyroidism or Hashimoto’s hypothyroidism, but many people also have a normal thyroid with normal thyroid levels. It is important to get your thyroid levels checked if you have Thyroid Eye Disease to screen for another inflammatory process in the body. Graves’ Disease causes abnormal thyroid hormone levels to circulate like the TSH, T4, and T3 and can result in heart palpitations, high blood pressure, anxiety, and restlessness. It is imperative to have any thyroid abnormality treated by an endocrinologist as it can be life-threatening.
How are Thyroid Eye Disease and Graves’ Disease different?
Thyroid Eye Disease involves your own immune system and antibodies that target the receptors on the orbital fibroblasts, specifically the IGF-1 receptor. Auto-antibodies in Graves’ Disease attack a related receptor called the thyroid stimulating hormone receptor, or TSH receptor. The IGF-1 receptor and TSH receptor are coupled together on the cell membrane and often work together. Because the receptors are interconnected, so a virus, illness, or stressor that triggers Graves’ disease or stimulates Thyroid Eye Disease can cause the other disease to also spike up with inflammation.
Can Treating Graves’ Disease also Treat Thyroid Eye Disease?
The short answer is no. Because Thyroid Eye Disease and Graves Disease are two separate disease entities, they require different management modalities. However, if someone with Thyroid Eye Disease has abnormal thyroid hormone levels, stabilizing those levels may also help improve the inflammation of Thyroid Eye Disease. Why is this? Abnormal hormone levels circulating in the body can stimulate overall inflammation in the body and make the immune system go crazy. Thus, having normal hormone levels in general removes the extra trigger for the autoimmune Thyroid Eye Disease. Unfortunately, there is no cure for autoimmune disease. Our goal is to get the inflammation down so much, that a person is not symptomatic.
How do I know if I have Thyroid Eye Disease?
Thyroid Eye Disease is a clinical diagnosis, and while there may be supportive tests that can be ordered, it takes the trained eye of a specialized TED expert. All of the symptoms are a result of inflammation around the eyes and expansion of tissues in a fixed, bony orbit. As the tissues change, the eye pushes forward, resulting in proptosis or bulging eyes. The inflamed eyelids retract backwards and open the eyes too much, resulting in dry eyes and redness. As the inflammation continues and the eye cannot project forward any more because of the stretch to the optic nerve, eventually, the large tissues behind the eye can start to squish the optic nerve, causing compressing optic neuropathy and permanent vision loss.
Some of the symptoms of Thyroid Eye Disease include:
- Eye pain or pain behind the eyes
- Redness of the eyes and eyelids
- Eyelid swelling and bags under the eyes
- Dry eyes
- Tearing
- Light sensitivity
- Double vision or diplopia
- Restricted eye movements
- Bulging eyes
- Eyelid retraction
- Vision loss
Also, the combination of symptoms of Thyroid Eye Disease can cause horrible disfigurement with bulging eyes that look abnormal. Many patients feel insecure and self-conscious about the appearance, which can then lead to sadness and depression. Don’t worry! There are options to make this better with Thyroid Eye Disease treatments.
Ultimately, it is best to see Dr. Murdock, who is a world-renowned TED expert for a screening evaluation of Thyroid Eye Disease. She sees patients in South Florida who come from across the globe who have difficulty getting diagnosed for this very complex disease.
What do I do if I have Thyroid Eye Disease?
The first step is to seek the help of a TED expert, like Dr. Murdock in South Florida and Miami. She will talk to you extensively about all of the options for Thyroid Eye Disease Treatment. This can include lifestyle changes, medications, and surgical options. As an autoimmune disorder, the goal of Thyroid Eye Disease treatment is to control inflammation as much as possible.
Lifestyle Changes
This can start with a few lifestyle changes and over-the-counter recommendations.
Stop smoking! Smokers have 7x more severe Thyroid Eye Disease than non-smokers.
Autoimmune Diet – Avoid inflammatory triggers like gluten, sugar, and dairy. Healthy foods and a plant-based diets are recommended.
Vitamin D Supplements – People who are vitamin D deficient can have improved Thyroid Eye Disease with restoration of normal Vitamin D levels.
Selenium Supplements – In select populations of people with early and mild Thyroid Eye Disease, selenium may help with inflammation.
Ocular lubrication – Artificial tears throughout the day and ointment or gel for the eye at night can help keep the eye lubricated and feeling better.
Medical Therapy
In 2020, a breakthrough IV treatment changed many of the treatment models for Thyroid Eye Disease. Extensive research has proven that by blocking the IGF-1 receptor, the inflammation in Thyroid Eye Disease can be shut down, causing many of the soft tissue changes to reverse back to normal. TEPEZZA (teprotumumab) is the first FDA-approved treatment for Thyroid Eye Disease. Dr. Murdock was one of the first TED specialists to use teprotumumab in the world, and she was involved in the original clinical studies for this treatment. Because of her early and robust experience in treating Thyroid Eye Disease patients with teprotumumab, she has traveled across the world to help educate other providers and specialists.
Based on the clinical data, teprotumumab has been shown to improve the following symptoms of Thyroid Eye Disease:
- Proptosis (bulging eyes)
- Double vision
- Signs and symptoms of inflammation (eyelid swelling and redness, pain)
- Quality of life
Now, TEPEZZA (teprotumumab) and every treatment option has risks of certain side effects. A thorough evaluation with Dr. Murdock will include an in-depth conversation about the risks and benefits of TEPEZZA in each individual patient with Thyroid Eye Disease. She can also discuss ongoing clinical trials in Miami and South Florida that are investigating new medications with less side effects that have great potential to treat Thyroid Eye Disease.
Surgery
The mainstay of treatment to restore a person’s original appearance has always involved reconstructive surgery. This can range from an orbital decompression to a small procedure tweaking the position of the eyelids. While surgery can sound scary, Dr. Murdock has performed thousands of procedures for Thyroid Eye Disease and uses her cosmetic surgery and reconstructive techniques to provide the best outcomes for her patients.
Book your consultation with a TED expert today
Don’t suffer with eye pain, redness, teary eyes, puffy eyelids, and double vision any longer. Don’t avoid photos with family or feel insecure about the change in your appearance. Don’t sit confused by other providers who don’t fully understand Thyroid Eye Disease and the complexities of the disease. Schedule a consultation with Dr. Murdock in the Miami area in South Florida today, and take back control of your disease and your life.
