Gary Joseph Lelli, MD, of the Department of Ophthalmology at Weill Cornell Medicine talks about thyroid eye disease due to Graves’ disease, including which clinicians are most likely to diagnose this condition and the most common symptoms in this highly variable rare condition.
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, commonly referred to as thyroid eye disease (TED).
Which Specialty Usually Diagnosis a Person with Graves’ Disease and Thyroid Eye Disease?
“Most patients are going to be seeing either a primary care doctor or an endocrinologist to make that diagnosis of Graves’ disease,” noted Dr. Lelli, adding, “although if patients have the eye findings, sometimes they come to the ophthalmologist first, or whoever their eye care provider is. They notice these eye findings and say ‘you might need to have your thyroid level checked because we’re seeing certain signs and symptoms of thyroid eye disease, and then they get diagnosed that way via the
endocrine or primary care doctors.”
Dr. Lelli also noted that even if a person with Graves’ disease does not have thyroid eye disease, they should be examined by an ophthalmologist to get a baseline assessment. “It’s a progressive disease and it can get worse and we’d certainly like to catch these patients at the beginning and have a baseline on them,” stated Dr. Lelli, adding that if they do have thyroid eye disease, that can require treatment for the Graves’ disease to be modified. “One treatment in particular that is known to worsen thyroid eye disease is radioactive iodine and so if a patient has thyroid eye disease we want to know ahead of time so we can help our endocrinologist make a good informed decision about what the best treatment.”
Symptoms of Thyroid Eye Disease
“The most common symptom,” according to Dr. Lelli, “is upper eyelid retraction, which occurs in about 90% of patients with the thyroid eye disease. What that means is the upper eyelid pulls up too high and you oftentimes will see some white over the colored part of the eye – that’s called superior scleral show,”
Other symptoms can include dry eyes, inflamed, light sensitivity, and often the sensation of a foreign body present in the eye.
Patients may also present proptosis or exophthalmos. “All that means is that the eyeballs are pushing out too far – they’re swelling behind the eyes and the eyes push out or bulge out and that will happen in about 50% of patients with thyroid eye disease.”
Another common symptom is double vision and according to Dr. Lelli, that occurs in about 40% of patients with thyroid eye disease.