Gary Joseph Lelli, MD, of the Department of Ophthalmology at Weill Cornell Medicine talks about the incidence and treatment options for thyroid eye disease due to Graves’ disease.
Graves’ disease is an immune system disorder that results in the overproduction of thyroid hormones (hyperthyroidism). A significant portion of persons with Graves’ disease – up to 50% – will also have eye problems.
Incidence
“It is a more common disease than you may realize. It affects 16 out of a 100,000 women and three out of a 100,000 men and so it’s more common in women,” noted Dr. Lelli, adding, “there’s a bimodal age distribution but the most common presenting ages in the early to mid 40s, so the average age of patients diagnosed with this disease is 43 but there’s a there’s a peak of onset around the early to mid 40s and then a second peak around the early to mid 60s.”
Dr. Lelli also noted that smokers with Graves’ disease are more likely to develop thyroid eye disease and that the symptoms will be more severe. “If you have a patient with Graves disease who smokes, they’re about seven times more likely to develop thyroid eye disease than a patient with Graves’ disease who doesn’t smoke — so smoking cessation is huge for all patients who come in with Graves’ disease.
Treatment Options
“It’s important that they have an endocrinologist and that that endocrinologist is trying to achieve a normal thyroid state – that maybe with medications, it maybe with radioactive active iodine (which can worsen the eye disease), or it may be with surgery,” noted Dr. Lelli.
With regard to managing the thyroid eye disease, Dr. Lelli stated that treat will vary on the most common symptom.
“The most common is dry eye from upper eyelid and lower eyelid retraction and proptosis, the eye basically is bulging out and that leads to more exposed eye and more irritations,” said Dr. Lellis, adding, “ we treat that symptomatically with preservative-free artificial tear drops, sometimes point mints or gels at nighttime. I recommend they run a humidifier in the air in the in the area where they sleep to keep the air moist. Or we’ll do some medicated drops, sometimes anti-inflammatory eye drops.”
“The second manifestation of the disease that can become really debilitating for the patients is double vision,” stated Dr. Lelli, adding, “we typically will either recommend that they patch one eye because if you have one eye to use at one time you won’t see double. Sometimes we can use a stick-on prism
for glasses called it for an L prism if the double vision is stable, which typically in these patients it’s not because again, it’s a progressive disease.”
Surgery and high doses of corticosteroids may also be needed for these patients but should only be reserved for more severe cases.