What is Thyroid Eye Disease (TED)?

Eye problems occur relatively commonly with thyroid disease. TED is also known as Thyroid Associated Ophthalmopathy (TAO) or Grave's Ophthalmopathy. In a small proportion of patients (3-5%) it may be require intensive treatment and can be vision threatening. The natural history of TED follows Rundle's Curve. The initial phase usually of a few months is associated with worseing of the TED which reaches a plateau and then spontaneously improves. The initial phases can last 1-2 years until a "burnt-out" stage occurs afterwhich change is rare. The management of TED is based on where on the Rundle curve the patients' TED is thought to lie."Active" disease" implies active inflammation and relates to the early phase of Rundle's curve where there is a place for medical or surgical treatment while "inactive" disease will only respond to surgical correction. The separation of active from inactive diseaseis crucial and can be achieved using a numerical score devised by Mourits.The Mourits score gives a value for activity.Ten signs or symptoms are given a score of one and any patientwith a score three or higher or whose score appears to be increasing is judged as having active disease.


Bulging red eyes in thyroid eye disease

Who gets TED?

Eye problems are most commonly associated with Grave's disease (up to 50% of patients may have signs if examined carefully), but patients with Hashimoto's thyroiditis may also develop problems. In rare cases it can affect patients with primary hypothyroidism and thyroid carcinoma. Those with toxic multinodular goitre, toxic adenoma or diffuse micronodular goitre are usually unaffected.

TED usually occurs in middle age but it may affect a teenagers to those in their 80s (it may even affect newborn babies). Women are much more commonly affected than men (approximately 4 women are affected for each man).

Factors that affect the development of TED include:

  • Heredity (30% of patients have a family history of TED and if a twin has TED there is a 1/3-2/3 chance that the other twin will develop problems)
  • Stress (this is difficult to define but is thought to play a part in the development of TED)
  • Smoking (TED is usually worse in those who smoke cigarettes)
  • Environment (because the brother or sister of an affected twin does not always develop TED, as yet unidentified environmental factors must be important)

Source: Mr Naresh Joshi

There was an exellent clinical review of TED in the British Medical Journal in 2009 This is very clearly written and although written for professionals is quite suitable for the lay public. The reference is:-

Thyroid eye Disease:Petros P,Neoh C,Dickension J. BMJ 2009,338 645-650