What are the symptoms and treatment options for thyroid eye disease?

From the Guidelines

Thyroid eye disease causes symptoms including eye bulging (proptosis), eyelid retraction, double vision, eye redness, pain, and dry eyes, and treatment options depend on disease severity, with the goal of reducing morbidity, mortality, and improving quality of life. The symptoms of thyroid eye disease can be managed with various treatments, including artificial tears for dry eyes and lubricating ointments at night, cool compresses and sleeping with the head elevated for mild inflammation, and medical treatments such as selenium supplements (200 mcg daily) for mild cases and corticosteroids (such as oral prednisone 40-60 mg daily, tapered over several weeks) for moderate to severe inflammation 1.

• Treatment options for thyroid eye disease include:
  • Medical treatments: selenium supplements, corticosteroids, and teprotumumab, an IV medication given every 3 weeks for 24 weeks, which is effective for reducing eye bulging 1
  • Orbital radiation therapy for muscle inflammation
  • Surgical options: orbital decompression to create more space for the eyes, eye muscle surgery to correct double vision, or eyelid surgery to improve appearance and function 1
• The disease typically follows a pattern of active inflammation for 6-24 months followed by a stable phase, so treatment timing is important, and smoking cessation is essential as smoking worsens symptoms and reduces treatment effectiveness 1
• A multidisciplinary approach to TED treatment is recommended, combining the expertise of medical specialists in endocrinology, oculoplastics, and neuro-ophthalmology as indicated, and the ophthalmologist should discuss the findings, explain the disorder, provide diagnosis, and discuss management options with the patient and any caregivers 1.

The most effective treatment plan should be individualized based on the patient's specific needs and disease severity, with the goal of reducing morbidity, mortality, and improving quality of life. Patients with thyroid eye disease should be carefully monitored for vision loss secondary to compressive optic neuropathy, and managed for binocular diplopia, compensatory head posture, and associated elevation in intraocular pressure (IOP) 1. Referral to an orbital specialist is recommended for patients with vision-threatening disease, moderate to severe exophthalmos, and/or significant orbital pain related to TED 1.

From the Research

Symptoms of Thyroid Eye Disease

• Swollen extraocular muscles and orbital fat 2
• Lid retraction, oedema and redness of the eyelids and conjunctiva 2
• Proptosis (bulging of the eyes) 2, 3, 4
• Diplopia (double vision) 2
• Optic neuropathy (damage to the optic nerve) 2, 4
• Compressive optic neuropathy (compression of the optic nerve) 4, 5
• Restriction of proptosis (limited movement of the eyeball) 4
• Exophthalmos (bulging of the eyes due to increased orbital content) 4, 5
• Corneal damage 4
• Ocular motility disturbances (abnormal movement of the eyes) 4

Treatment Options for Thyroid Eye Disease

• Non-surgical management:
  • Observation alone 6
  • Oral selenium 6
  • Glucocorticoid therapy 6, 3
  • Cyclosporin 6, 4
  • Mycophenolate 6
  • Rituximab 6
  • Immunoglobulin 6
  • Teprotumumab 6, 2
  • Orbital radiotherapy 6
• Surgical management:
  • Orbital decompression 6, 3, 4, 5
  • Strabismus surgery 6
  • Eyelid surgery 6
  • Tarsorrhaphy (temporary or permanent closure of the eyelids) 6
• Immunomodulatory therapy:
  • Intravenous methylprednisolone 6, 4
  • Oral prednisolone 4
  • Cyclosporin A 4
• Other treatments:
  • High-dose intravenous methylprednisolone therapy for active vision-threatening disease 6
  • Tocilizumab (an interleukin-6 receptor blocker) for steroid-resistant patients 2