Thyroid hormone is an essential hormone produced by the thyroid gland, which is located in the neck. Patients with excessive thyroid hormone in the circulation may have any of the following symptoms:

• neck swelling from an enlarged thyroid gland (goitre)
• intolerance to heat
• sweatiness
• increase in appetite and loss of weight
• tremors
• palpitations
• tiredness
• anxiety, nervousness and bad temper

Thyroid eye disease is an eye condition related to thyroid disease. This condition tends to affect middle-aged women unaccompanied by abnormal hormone levels. However, the manifestations of TED may occur.

Symptoms

Patients with TED may complain of the following:

• a "staring" appearance
• protrusion of the eye
• tearing
• eye discomfort and gritty sensation
• eye redness
• puffy eyelids
• double vision
• squint blurred vision

Complications

The most important, but fortunately rare, complication is loss of vision. This is usually due to compression of the optic nerve by swollen tissues surrounding the eye. Urgent treatment is required otherwise visual loss can be permanent. Other complications include glaucoma (raised pressure within the eye) and exposure of the front surface of the eye (due to inability to completely close the eyelids).

Natural Course

It is common for thyroid eye disease to fluctuate within the first few years of the disease. Beyond this time, the disease tends to stabilise. It is important for you to be seen and treated by a physician for the underlying thyroid disease throughout this period. However, the eye disease may continue to progress even if your thyroid status is under control.

Local Therapy

Tear substitutes and lubricants help to protect the surface of the eye from drying. Taping your eyelids closed at night is also helpful. Sleeping on extra pillows reduces swelling around the eyes by elevating the head. Double vision can be troublesome if it affects straightforward and down-looking positions (as in reading). Special lenses called prisms may relieve this.

Medical Treatment

Your physician will advise you on treatment for thyroid disease. Steroids are used in selected cases. The effect of steroids is temporary and once it is stopped, symptoms often rebound.

Steroids cause many undesirable side effects when used over a long period of time. While you are on steroid treatment, your ophthalmologist will monitor you for side effects, which include obesity, gastric symptoms and bleeding, aggravation of diabetes and high blood pressure and decrease resistance to infection.

Radiation

Radiation is an effective way of reducing swelling of tissue around the eye and relieving compression of the optic nerve. The dose used is very low and thus very safe.

Surgery

When vision is threatened, early lid or orbital surgery may be necessary. Otherwise, surgery is usually reserved for stable, inactive disease with the following complications:

• abnormal staring appearance
• severe protrusion of the eyes
• disturbing double vision not relieved by prism glasses
• drooping or sagging of tissues around the eyes

Thyroid eye disease should be treated by ophthalmic surgeons who specialise in conditions affecting the eyelids and socket.

* This is a general guide. If in doubt, please consult your doctor.