Thyroid Eye Disease

Thyroid eye disease with proptosis or exophthalmos. © 2019 American Academy of Ophthalmology

Thyroid Eye Disease




Graves disease is an autoimmune disease that affects the thyroid gland. This kind of disease can also involve the orbit and the eye in a condition that is called thyroid eye disease (TED).

Tissues and muscles in the orbit will be infiltrated with inflammatory cells and also there will be also deposition and accumulation of glycosaminoglycan.

These two factors will cause these tissue and muscles to swell and with time they will compress in optic nerve and the globe.



Signs of Thyroid Eye Disease


1- Proptosis. Forward and outside displacement of the eye globe in the orbit.

2- Dry Eye syndrome.

3- Exposure keratopathy. Which can cause corneal ulcer and infection.

4- Restrictive Myopathy which causes incomplete movements of the globe in certain direction. This will cause double vision.

5- Glaucoma. Can be due to open angle glaucoma or due to compression of the swelled muscles and tissue on the globe.

6- Optic nerve compression which will cause optic disc swelling and atrophy.

Acute optic nerve compression is a medical emergency which required inpatient treatments with high dose of corticosteroids such as methylprednisolone and sometimes it might requires radiation therapy and orbital decompression surgery.

7- Choroidal fold and macular edema. Due to compression of the tissue on the globe.



Selenium to Treat Thyroid Eye Disease

So far there isn’t any effective prevention and treatment of thyroid eye disease. We only treat the complications such as dry eye syndrome, corneal ulcer, glaucoma and so on.

A study on 159 patients with mild TED was conducted at the University of Pisa, Italy. These patients were divided into three groups in which one group was on six-month course of selenium selenite, 100 micrograms twice daily, the second group was on 600 milligrams of pentoxifylline ( Anti-inflammatory medication) while the third group was on Placebo.

After six months, patients who were on Selenium showed improvements in signs and symptoms of thyroid eye disease and also in quality of life while the other two groups didn’t show any improvement.

Patients on selenium also showed improvements of their conditions that were lasted for another six months after the study ended and they didn’t show any side effects of the medication.

Results of the study are published in the May 19 issue of the New England Journal of Medicine.



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