Managing Thyroid Eye Disease

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If you’ve been diagnosed with hyperthyroidism (overactive thyroid), you might also be concerned about developing thyroid associated ophthalmopathy (TAO), also known as thyroid eye disease. This is an autoimmune condition that usually occurs in people with hyperthyroidism or a history of an overactive thyroid due to Graves’ disease. TAO can cause changes in the appearance of the eye and eyelids, ocular discomfort, double vision, dry eyes and tearing, corneal exposure, and even blindness in some cases.

“TAO can be a life-altering condition for many patients,” said Dr. Sara Tullis Wester, an oculoplastic surgeon at the Bascom Palmer Eye Institute, part of the University of Miami Health System. “In patients with active TAO, it can present in a variety of ways. It’s really important that symptomatic patients be seen by someone who manages thyroid eye disease, so that we can treat them appropriately.”

If you are at risk for TAO, you can help lower your chances for developing this condition. Stabilize your thyroid blood levels in the normal range. Quit smoking and avoid secondhand smoke because smokers have up to an eight times increased risk of developing severe TAO. Ask your ophthalmologist how to further support your eye health.

If you have evidence of active TAO, it is very important that you consult both an ophthalmologist and endocrinologist. Speak with your doctors about medical and surgical options to address both functional issues (loss of vision, double vision, dry eyes) and cosmetic aspects of this disease. There are a variety of ways to help manage the symptoms and improve your overall quality of life.

How to support your eye health

  • Use lubricating eye drops, such as artificial tears, to help relieve dryness and scratchiness, especially before you go to sleep.
  • When you’re outside, protect your eyes from the wind and the sun’s harmful rays by wearing sunglasses.
  • Taking the supplement selenium (100 ug twice daily as sodium selenite) may decrease ocular problems and reduce progression of mild TAO. Speak with your doctor about whether you should begin selenium supplementation.

Sleeping modifications

  • If you have significant inflammation, it’s best to sleep with your head elevated.
  • Eye ointment may be beneficial while sleeping to help with dryness, particularly in spaces with air conditioning or a fan.
  • If your eyes do not close completely when you are sleeping, try using an eye shield in addition to the ointment while sleeping.

Medical options

In January of 2020, the U.S. Food and Drug Administration approved the first medical treatment for thyroid eye disease, known as Tepezza (Teprotumumab). “This treatment targets a receptor that has been shown to be involved in TAO,” said Dr. Wester, who specializes in the treatment of TAO. “Phase 2 and Phase 3 studies showed that it had a significant benefit over placebo in improvement of proptosis (eyeball bulging), inflammation, and double vision.” Talk to your provider about whether this treatment might be of benefit to you.

Other treatments, such as other medications or radiation, are sometimes used as well.

Surgical options

In some cases, ophthalmologists will recommend orbital decompression surgery. This involves removing the bone between the eye socket (orbit) and sinuses to allow more space for the swollen tissues. In addition, sometimes surgery can help reduce double vision and changes in the eyelid appearance (retraction).

Learn more

Your ophthalmologist and endocrinologist can help you understand your unique risk factors for TAO and what you can do to help avoid developing the condition, slow its progression, or manage the symptoms. If your condition is advanced, you may discuss surgery as an option to provide relief.

The experts at Bascom Palmer provide testing, treatment, and patient support services for those facing thyroid associated ophthalmopathy.

In an upcoming patient webinar, Dr. Wester will discuss living with and managing thyroid eye disease. This live talk will be available online only to registered participants on Wednesday, May 20, at 8 p.m. To register for this free webinar, call 571-288-9188.


Dana Kantrowitz is a contributing writer for UMiami Health News.


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