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Thyroid Eye Disease
What is thyroid Eye Disease?
Thyroid Eye Disease (TED) is a an autoimmune
disease affecting the tissues around the eye. It can
occur in all races and ages. Thyroid eye disease
(Graves’ disease) causes the eyes to bulge forward
and the eye aperture to widen. It can lead to double
vision, swelling around the eyes, discomfort, and in
severe cases, loss of vision.
Who Gets Thyroid Eye Disease?
If you have a thyroid disorder, (Hyderthyroidism or Hypothyroidism) there is an approximately 25-50%
chance that you may develop the ‘eye disease’. Of these, very few will be severe, and sight-threatening.
What causes Thyroid Eye Disease?
In a normal person, the amount of fat behind the eyeball is
constant and the eyeballs move normally. In TED, excess fat gets
deposited behind the eyeball, and the muscles that move the
eyeball get swollen. Swelling and deposition of certain chemicals
(glycosaminoglycans) in these muscles causes the eye to protrude.
Simply put, the tissues behind the eye enlarge, making the eye
prominent. The eyes may not be able to move together, leading to
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How do I know I have Thyroid Eye Disease?
Many patients confuse their systemic thyroid disorder (affecting the whole body), with the thyroid eye
disease (TED). Systemic thyroid disorder (hyper or hypothyroidism), is caused by excess or poor
secretion of thyroid hormones T3 and T4 by the thyroid gland (located in your neck). In order to diagnose
this, one has to check thyroid blood levels in any standard lab.
The thyroid eye disease, on the other hand, is quite independent of the systemic disorder, though both
often co-exist. Thyroid eye disease is diagnosed clinically by an ophthalmologist, by assessing your
vision, proptosis, swelling, and eye movement restriction. In addition, a CT scan may be required.
Hence, systemic thyroid disorder needs blood tests, and TED needs eye check-up. These two are fairly
independent of each other in their onset, and course.
I am diagnosed with Thyroid eye disease. What happens next?
TED typically has an active phase followed by a stable (inactive) phase. In effect, the active phase may
last from 6 – 18 months, during which the patient may experience discomfort, swelling and redness
around the eyes and progressive prominence of the eyeballs. But there’s no reason to be alarmed as
reduction in vision is rare and occurs only if the optic nerve is compressed due to swelling. Double vision
may, however, occur if the eye muscles are severely affected. Treatment during this phase is aimed at
reducing the immunological inflammation (active swelling), usually with the use of medications
(steroids), or other immunosuppressive agents and, hopefully, limiting the adverse consequences of the
This active phase can be simply compared to a house on fire. While it is on flames, the doctor
concentrates to extinguish the fire (immune swelling) with water or fire-extinguisher (steroids). One
cannot think of re-building the house while the fire is still on!
Once the TED has become inactive, it is time to perform corrective surgeries that will rectify the damage
caused during the active stage. This can be compared to the repair carried out after the house fire is
Surgical correction of the eye protrusion (proptosis), aligning the eye muscles to correct double vision,
narrowing the eyelid apertures, or simply reducing the fat pockets in the eyelids is done at this stage.
My Thyroid specialist (Endocrinologist) is already treating me. Won’t that make my eyes normal?
Please understand that the TED is associated with, but not caused by, abnormal thyroid hormone levels.
Your endocrinologist will help normalize the thyroid levels in your blood, which is essential for normal
functioning of your entire body. However, this will not improve your eye condition. It is a common myth,
that the eye disease would normalize once normal thyroid levels are controlled. To bring your eyes back
to normal, corrective surgery is most often required.
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Can Surgery Restore my normal appearance?
Yes, surgery can bring
back your normal
appearance to a great
extent. The surgical
correction is often done
in stages, and depends
upon the extent of the
For bulging eyes, a
is performed as the first
step. Imagine your
bony socket as the icecream cone, and your
eyeball as the icecream scoop over it.
widens the bony
socket (enlarges the
cone) so that the
eyeball (your scoop)
sinks into a na
Eye muscle surgery (squint surgery) is performed next to improve double vision if present.
Finally, Eyelid surgery is performed as the last stage, giving you a more natural, aesthetically pleasing
Will my Insurance cover this surgery?
Health insurance will cover the costs of a reconstructive surgery for thyroid eye disease.
I am planning to get surgery done. Will my thyroid eye disease recur?
Recurrence of the active phase (which means active phase reappears for the second time) is very
uncommon, and occurs in less than 5% of individuals.
For more information or to book an appointment, write to [email protected]