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From time to time, we will uodate this page with basic medical information gathered mainly from serious online pages, organisations, charities and major medical actor and look forward to sharing with you more iside details from the amazing Medical Teams working on improving Patients Lives.
We hope this basic definition helps you understand the scale of TED effects on the Mind and Body!
Bijou@selfishted.org
THYROID EYE DISEASE
Graves' ophthalmopathy (also known as thyroid eye disease (TED), dysthyroid/thyroid-associated orbitopathy (TAO), Graves' orbitopathy) is an autoimmune inflammatory disorder affecting the orbit around the eye, characterized by upper eyelid retraction, swelling (edema), redness (erythema), conjunctivitis, and bulging eyes (proptosis).[1]
It is part of a systemic process with variable expression in the eyes, thyroid, and skin, caused by autoantibodies that bind to tissues in those organs, and, in general, occurs with hyperthyroidism.[1] The most common form of hyperthyroidism is Graves' disease. About 10% of cases do not have Graves' disease, but do have autoantibodies.
The autoantibodies target the fibroblasts in the eye muscles, and those fibroblasts can differentiate into fat cells (adipocytes). Fat cells and muscles expand and become inflamed. Veins become compressed, and are unable to drain fluid, causing edema.
In more severe and active disease, mass effects and cicatricial changes occur within the orbit. This is manifested by a progressive exophthalmos, a restrictive myopathy that restricts eye movements and an optic neuropathy. With enlargement of the extraocular muscle at the orbital apex, the optic nerve is at risk of compression. The orbital fat or the stretching of the nerve due to increased orbital volume may also lead to optic nerve damage. The patient experiences a loss of visual acuity, visual field defect, afferent pupillary defect, and loss of color vision. This is an emergency and requires immediate surgery to prevent permanent blindness.
http://en.wikipedia.org/wiki/Thyroid_eye_disease
ABOUT THYROID EYE DISEASE
Thyroid eye disease (thyroid orbitopathy or TO) is actually a condition of the soft tissues such as the fat and muscles surrounding the eyes. The condition is characterised by a period of inflammation and engorgement of these tissues, followed by a healing response.
The condition most commonly occurs in association with an overactive thyroid gland, but also occurs with an under active thyroid gland; an identical picture sometimes occurs when the thyroid gland is not itself affected.
Thyroid gland
The thyroid is one of the body's endocrine glands; these are glands which produce hormones. Hormones are chemical messengers in our blood streams, which co-ordinate long term changes in function. The thyroid is located in the neck just below the Adam's apple, and its hormones regulate our metabolism.
Diseases of thyroid
The main problem affecting the thyroid is auto-immune disease. Thyroid cancers also occur. The effect of thyroid disease is felt as either an over-activity or under-activity of the gland, and therefore either a speeding up or a slowing down of metabolism.
Auto-immune disease and the thyroid
Auto-immune problems are caused by inappropriate behaviour of the body's immune system. The immune system usually fights off infection but in auto-immune disease it attacks the body's own tissues with auto-antibodies. At the moment the reason for this is not entirely clear.
Why thyroid problems affect the eyes
When an auto-immune attack starts on the thyroid, it responds by producing more of its hormones. At the same time the auto-antibodies attacking the thyroid gland also attack the tissues around the eyes.
More information on thyroid problems is available from the British Thyroid Association, details at the end of this page.
How thyroid disease affects the eyes
The commonest problem is dry eyes. This is because, in auto-immune disease, more than one organ may be attacked, and commonly the thyroid and all the orbital contents (the soft tissues around the eye), including the lacrimal gland, are attacked by the immune system. The lacrimal gland produces the tears in our eyes, so when it is affected fewer tears are produced. As a result, the eyes may feel dry and gritty. It is worth noting that, although the eyes are described as 'dry', they can water and produce more tears than normal.
As the orbital contents (the soft tissues around the eye) become inflamed, all the tissues of the orbit become red and swollen.
· The eyelids become puffy and red (lid swelling)
· The muscles of the eyelids contract, producing a staring appearance (lid retraction)
· The muscles and fat surrounding the eye swells, pushing the eyes forward so that they bulge out of the orbits (exophthalmos)
· Lid retraction and exophthalmos make the dry eye symptoms worse.
· The swelling of the muscles which move the eyes produces unequal movements and double vision (diplopia)
· The orbits may become painful, particularly on eye movement.
How thyroid orbitopathy affects sight
If the muscles become swollen, then this can affect how well the muscles are able to control the ability of the eyes to move together. This can cause double vision. This is a symptom which occurs when the eyes do not quite point in the same direction and therefore each sends a slightly different message to the brain. When this happens our brains 'see' two of everything. This can make activities like reading very difficult, and driving very dangerous. If someone develops double vision then they must stop driving, it is illegal to drive with double vision which isn't controlled.
If you do develop double vision then you have to inform the Driver and Vehicle Licensing Authority (DVLA) and, usually, they will contact your ophthalmologist for a medical report. If your double vision then becomes controlled with glasses at a later date the DVLA will declare you fit to drive. Not informing the DVLA of double vision could have serious consequences for your insurance status and you would be also be driving illegally.
In severe Thyroid Orbitopathy, especially in younger patients whose firm tissues do not allow the eyes to bulge forwards, the pressure inside the orbits increases, compressing the optic nerve and causing sight problems. The optic nerve carries the messages from the eye to the brain and can be damaged by pressure.
If the pressure starts to compress the optic nerve sight may become dim, colours begin to look washed out, and the visual field may constrict. If this starts to happen, then medical attention needs to be sought as soon as possible, to reduce the pressure on the optic nerve before permanent damage occurs.
The treatment options for optic nerve compression are steroids, immunosuppressant drugs, orbital radiotherapy and emergency orbital decompression surgery. These all aim to lower the pressure on the optic nerve and hopefully avoid permanent damage.
http://www.rnib.org.uk/eyehealth/eyeconditions/eyeconditionsoz/Pages/thyroid_disease.aspx
