THYROID EYE DISEASE; INTRO & ITS EARLY SIGNS AND SYMPTOMS -By Basirah Adejoke

 

Basirah Adejoke Musa - Bayero University, Kano.

 

THYROID EYE DISEASE; INTRO & ITS EARLY SIGNS AND SYMPTOMS

Thyroid Eye Disease (TED) is not just another eye disease; it is one that needs to be studied intentionally as the etiology is yet to be well understood. Research by Shalin et al. (2023) tells us that it is the most common cause of both unilateral and bilateral proptosis in adults and about 25 to 50% of Grave disease (GD) cases present with thyroid eye disease.

 

TED is a chronic autoimmune inflammatory disease of the orbit, involving the orbital fibroblasts, adipocytes, and lymphocytes, which results in the expansion of retro-orbital fat and the extraocular muscles.

 

I would hate to bore you with details, but let's backtrack for a minute, because now you might be wondering what Graves disease is (remember I mentioned that 25-50% of Graves Disease cases present with TED?) and how it is related to TED.

 

Graves disease is an autoimmune disorder of the thyroid gland characterized by excessive production of the thyroid hormone due to the presence of circulating autoantibodies binding to the thyroid hormone receptor and causing its stimulation, resulting in hyperthyroidism and goitre. This of course affects the thyroid, which can lead to a Thyroid storm, and affects other areas such as the skin of the lower legs (Graves Dermopathy), and the eyes (Graves Ophthalmopathy or TED).

 

TED can occur at any stage of life but it mostly occurs during midlife (20-50 years), which brings us to why you need to know what to look out for. In other words, what are the earliest signs and symptoms that may prompt an observant individual to have their suspicions?

 

EARLY SYMPTOMS OF TED

 

●      Dry Eye/Gritty Sensations - you may feel that something is in your eyes.

●      Lacrimation - Excessive tearing in response to the gritty sensations or irritation.

●      Photophobia - Lights may begin to get uncomfortable.

Later in the disease process, a patient may experience symptoms such as redness, discomfort and a forward displacement of the eyes, pain, which may worsen with eye movements, as well as eyelid changes.

 

EARLY SIGNS OF TED

●      Any change in the usual appearance of the eyes.

●      Eyelid retraction known as Dalrymple sign, the most common sign, is found in 90% of TED patients and causes exposure of the white part of the eyes (sclera).

●      Lid lag of the upper eyelid during downward gaze as well as swelling of the lids.

●      Diplopia, due to involvement of the extraocular and the levator muscles.

As the disease progresses, other signs that present are incomplete and frequent blinking, abnormal upper eyelid pigmentation, paralysis of all the extraocular muscles, abnormal pupillary reactions, and staring and frightened appearance of eyes.

 

TED is a real issue - but the real question is: how often do you get your eyes checked?!