(Endocrine & Metabolic)

Overview

• Affects 25-50% of patients with Graves’ Disease
• F>M
• Autoimmune response against TSH receptor leads to retro-orbital inflammation. Inflammation results in glycosaminoglycan and collagen deposition in the muscles.
  • Auto-antibodies target the extraocular muscles, causing swelling behind the eye which results in proptosis of the eyeballs
• Smoking → most important modifiable risk factor for development of thyroid eye disease

<aside> 💡 In context of hyperthyroidism, Thyroid Eye Disease only occurs in patients with Graves Disease

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Making Diagnosis

Clinical Features:

• Patients may be eu-, hypo- or hyperthyroid
• Exophthalmos
• Lid Lag → upper eyelid is higher than normal with the globe in downgaze
• Conjunctival Oedema
• Optic Disc Swelling
• Ophthalmoplegia (paralysis of muscles surrounding eye)
• Inability to close eyelids → leads to sore, dry eyes. If untreated patients at risk of exposure keratopathy