Effective Thyroid Eye Disease Treatments: Which One Should You Choose?

I know it can be worrying to notice changes in your body, especially when it involves such a sensitive area as your eyes. But first thing first, let’s talk about the TED definition itself.

Thyroid Eye Disease (TED) is an autoimmune condition that affects the tissues around your eyes, including muscles, fatty tissue, and connective tissue. It’s often related to Graves’ disease, an autoimmune disorder that affects the thyroid gland and can cause hyperthyroidism or hypothyroidism.

The symptoms of TED can vary, and you might experience:

1. Feeling of grittiness in your eyes: It can feel like you have sand in your eyes—quite uncomfortable.
2. Sensitivity to light: Your eyes might become more sensitive to light, which can be painful.
3. Pain behind your eyes or with eye movement: This pain can be quite significant and might worsen with eye movement.
4. Redness of your eyes: Swelling or irritation can cause redness.
5. Dry eyes: Your eyes might feel dry or lack moisture.
6. Excessive tearing: You might experience excessive tearing, even if your eyes feel dry.
7. Puffy or red eyelids: Your eyelids might become swollen or red.
8. Forward bulging of your eyes (proptosis): Your eyes might protrude outward.
9. Seeing double (diplopia): This happens when your eyes are not aligned properly, causing double vision.

It’s a great question, and one I get asked frequently. While TED can affect anyone, it’s true that women are more likely to develop this condition. It’s a fact that’s puzzled researchers for a long time.

According to various studies and medical literature, women are approximately 5 to 6 times more likely to develop TED than men. This disparity is largely attributed to the higher prevalence of Graves’ disease among women, which is an autoimmune disorder that often affects the thyroid gland and can lead to TED.

Several factors contribute to this higher incidence:

• Hormonal Influences: Hormonal fluctuations, particularly estrogen levels, might play a role in developing autoimmune diseases like Graves’ disease and TED.
• Genetic Predisposition: Women are more likely to inherit genetic traits that predispose them to autoimmune conditions.
• Environmental Factors: Stress, smoking, and certain medications may also contribute

If you’re a woman, TED can also occur after pregnancy. Managing TED during and after pregnancy can be particularly challenging due to hormonal changes and immune system adjustments. If you’ve experienced TED during pregnancy, you may need close follow-up to ensure the condition doesn’t worsen.

Sometimes, TED can develop or worsen during pregnancy, despite the body’s natural immune tolerance. This is often seen in women with pre-existing Graves’ disease, which can cause hyperthyroidism and lead to TED. Symptoms during pregnancy can include bulging eyes, double vision, and discomfort with eye movement.

TED is diagnosed through a combination of clinical evaluation, laboratory tests, and imaging studies.

1. Clinical Evaluation: This includes an eye exam to check for swelling, bulging eyes, and misaligned eyes, as well as vision tests to measure vision and eyelid openings.
2. Laboratory Tests: Blood tests to check thyroid hormone levels and antibodies, such as TSH, T4, T3, TSI, TRAb, and anti-TPO.
3. Imaging Studies: These include ultrasound to identify swelling and inflammation around your eyes, CT scans to detect enlarged eye muscles and structural changes, and MRI to assess inflamed tissues and compressed optic nerves.
4. Additional Tests: Eye pressure tests to check for increased intraocular pressure and an optic nerve check to assess optic nerve health.

Thyroid Eye Disease treatment range from non-surgical to surgical and targeted therapies, depending on the severity of your symptoms.

Non-Surgical Treatments

Non-surgical treatments are often the first line of defense in managing TED. These include:

1. Eye Drops: Over-the-counter eye drops can help relieve dryness and irritation. It’s essential to use lubricating drops and avoid those that reduce redness.
2. Selenium Supplements: In adults, the thyroid organ contains the highest concentration of selenium per gram of tissue. If your blood test shows low levels of selenium, it is a no-brainer to start on selenium supplements.
3. Aloe Vera Juice: Drinking aloe vera juice has shown some promise in reducing thyroid  inflammation in a few studies. Note that this is not specific to thyroid eye disease but more toward thyroid inflammation in general
4. Anti-Inflammatory Drugs: Oral steroids like Prednisone are used for bringing down systemic inflammation in the body, including inflammation in the eyes.
5. Teprotumumab: This new medicine, specifically for thyroid eye disease, is called teprotumumab (Tepezza®). Tepezza is a biologic inhibitor of the insulin-like growth factor-1 receptor (IGF-1R), and it’s been shown to be effective in treating moderately severe active TED with minimal side effects.
6. Acupuncture for Thyroid Eye Disease: Surprisingly effective, acupuncture is able to help women with TED. Find out more by looking up this article on acupuncture for TED by Chinese Doc. where you may see results as early as after one session. 
7. Botulinum Toxin A (BTA): BTA injections can effectively manage strabismus in active TED and residual deviations after strabismus surgery. This treatment is particularly useful if you have esotropia, where postoperative under-correction is more common.

Surgical Interventions

Surgical interventions are necessary for more severe cases of TED, particularly when non-surgical treatments are insufficient. Surgical options include:

1. Lateral Rectus Resection: This procedure can correct esotropia by resecting the lateral rectus muscle to improve eye alignment.
2. Muscle Rectus Muscle Resection: Typically performed after maximum recession of restricted muscles, it’s essential to avoid this surgery on restricted or enlarged muscles to prevent complications.
3. Surgery for Proptosis: This surgery can reposition the eye or its muscles, or remove scar tissue or parts of the eye socket bone, helping restore normal vision and improve the appearance of your eyes.