Question

Detail the clinical features and risk factors for thyroid eye disease.

Hint:

Smoking is the strongest modifiable risk factor for the severity of Thyroid Eye Disease and can significantly impact the prognosis.

Answer 1

Clinical Features of Thyroid Eye Disease:
1. Proptosis (Exophthalmos):
- Bulging eyes are a hallmark of TED, due to orbital fat expansion and extraocular muscle swelling. Proptosis can cause ocular surface exposure and dry eyes.
2. Diplopia (Double Vision):
- Caused by extraocular muscle involvement leading to misalignment of the eyes, especially when the inferior rectus or medial rectus muscles are affected.
3. Orbital Pain and Pressure:
- Inflammation of the extraocular muscles can cause discomfort, particularly when moving the eyes. Pain may be more severe in the acute inflammatory phase.
4. Redness and Swelling of the Eyes:
- Conjunctival redness, chemosis, and swelling of the eyelids are common, particularly in the early stages due to inflammation.
5. Dryness and Irritation:
- Reduced eyelid closure due to proptosis can cause corneal dryness, leading to burning, itching, or sandy sensation in the eyes.
6. Reduced Eye Movement:
- Restricted extraocular movements occur due to swelling or fibrosis of the extraocular muscles, resulting in difficulty moving the eyes and double vision.
7. Optic Nerve Compression:
- Loss of vision or visual field defects can occur if the optic nerve becomes compressed by the swollen muscles or retrobulbar fat.
Risk Factors for Thyroid Eye Disease:
1. Thyroid Dysfunction:
- Hyperthyroidism, particularly due to Graves' disease, is the most significant risk factor. Hypothyroidism, though less common, can also be associated with TED.
2. Smoking:
- Smoking is the most significant modifiable risk factor for TED. It increases the severity of the disease and the risk of developing optic nerve compression.
3. Age and Gender:
- TED is more common in middle-aged women, but it can occur in both genders. The disease typically presents between the ages of 30-50 years.
4. Family History:
- A family history of Graves' disease or thyroid disorders can increase the likelihood of developing TED.
5. Thyroid Antibody Levels:
- Elevated thyroid-stimulating immunoglobulin (TSI) and anti-thyroid peroxidase (TPO) antibodies can indicate an increased risk of developing TED.