What is life expectancy of Graves disease?
dE = – (ln 1.21)/0.098 for men, and - (ln 1.21)/0.10 for women. Thus the expected change in life expectancy for people with Graves’ disease in the UK, over 30 and under 45, is about -2 years, with the lower value of 1.1 giving -1 year, and the higher value of 1.5 gives -4 years.
What are the ophthalmologic manifestations of Graves disease?
- Weight loss
- Hyperkinetic behavior, thought, and speech
- Restlessness
- Lymphadenopathy and occasional splenomegaly
- Eyes
- Prominence of eyes, lid lag, globe lag
- Exophthalmos, lid edema, chemosis, extraocular muscle weakness
- Decreased visual acuity, scotomata, papilledema, retinal hemorrhage, and edema
- Goiter
- Sometimes enlarged cervical nodes
What are the side effects of Graves disease?
What are the symptoms of Graves’ disease?
- Hyperthyroidism. Symptoms of hyperthyroidism may include trouble sleeping and fatigue.
- Eye problems. More than 1 in 3 people with Graves’ disease develop an eye disease called Graves’ ophthalmopathy (GO). ...
- Skin problems. Rarely, people with Graves’ disease develop a condition that causes the skin to become reddish and thick, with a rough texture.
What are the complications of Graves disease?
Symptoms associated with Graves’ orbitopathy
- Changes in eye appearance, particularly eyelid or periorbital swelling, eye bulging
- Excessive lacrimation, often more pronounced on waking
- Incomplete closure of eyes at night (lagophthalmos), as reported by the partner
- Photophobia, need to protect eyes with dark lenses
What is the cause of Graves ophthalmopathy?
Cause of Graves' ophthalmopathy Graves' ophthalmopathy results from a buildup of certain carbohydrates in the muscles and tissues behind the eyes — the cause of which also isn't known. It appears that the same antibody that can cause thyroid dysfunction may also have an "attraction" to tissues surrounding the eyes.
What are the symptoms of Graves eye disease?
Symptoms of Graves' eye disease include: Feeling of irritation or grittiness in the eyes, redness or inflammation of the conjunctiva (the white part of the eyeball), excessive tearing or dry eyes, swelling of the eyelids, sensitivity to light, forward displacement or bulging of the eyes (called proptosis), and double ...
How is Graves ophthalmopathy treatment?
Mild symptoms of Graves' ophthalmopathy may be managed by using over-the-counter artificial tears during the day and lubricating gels at night. If your symptoms are more severe, your doctor may recommend: Corticosteroids. Treatment with corticosteroids, such as prednisone, may lessen swelling behind your eyeballs.
Is Graves disease the same as thyroid eye disease?
In Graves' disease, your thyroid is affected. When you have Thyroid Eye Disease, it affects the muscle and fat behind your eyes. TED often develops in people who have Graves' disease. But they are separate conditions that require different treatment.
What are the first signs of thyroid eye disease?
Early symptoms of thyroid eye disease are itching, watering or dry eyes and a feeling of grittiness of the eyes. Some people may notice a swelling around the eyelids and sometimes the front of the eye becomes swollen.
Can Graves eye disease be cured?
Graves' disease doesn't go away, but it can be successfully managed. Graves' disease and thyroid eye disease are connected — but separate — conditions. TED will follow its own course. Management of Graves' disease involves getting thyroid hormone levels into a target range.
How do you test for Graves ophthalmopathy?
A diagnosis of Graves' orbitopathy is clinical. Thyroid function studies can be helpful, but in some cases are normal. To determine if Graves' orbitopathy is present, your doctor may require more scans, such as a computerized tomography (CT) scan or MRI, to identify changes in the muscles around the eyes.
How long does Graves Ophthalmopathy last?
In most patients who develop Graves' ophthalmopathy, the eyes bulge forward or the eyelid retracts to some degree. Many patients with mild to moderate Graves' ophthalmopathy will experience spontaneous improvement over the course of two to three years or will adapt to the abnormality.
How do you get thyroid eye disease?
Who Gets It? The condition happens most often in people with too much thyroid hormone, or hyperthyroidism. Less commonly, it can happen if you have an underactive thyroid. Rarely, you can get it if you have normal thyroid levels.
Will my eyes go back to normal after Graves disease?
Once stabilized, it is unusual for the eyes to start changing again. Some patients are left with permanent changes, and in others the eyes return to normal.
Is Graves eye disease hereditary?
The inheritance pattern of Graves disease is unclear because many genetic and environmental factors appear to be involved. However, the condition can cluster in families, and having a close relative with Graves disease or another autoimmune disorder likely increases a person's risk of developing the condition.
How do you prevent Graves eyes?
Here are seven ways to ease the symptoms of thyroid eye disease.Use Lubricating Eye Drops. ... Ask Your Doctor if You Should Try a Selenium Supplement. ... Avoid Secondhand Smoke. ... Elevate Your Head. ... Try Taping. ... Wear Fresnel Prisms. ... Wear Sunglasses.
What is the life expectancy with Graves disease?
Long-term prognosis6 months1 yearWomen76.667.8Men81.678.9Age (median)<47 years80.976.228 more rows
What are the stages of thyroid eye disease?
There are two phases. The active phase, marked by inflammation, usually lasts from six months to two years. The focus during this stage is on medical treatment to relieve the eye symptoms. During the second phase, or the stable phase, inflammation and other symptoms have subsided.
How long does Graves eye disease last?
Many patients with mild to moderate Graves' ophthalmopathy will experience spontaneous improvement over the course of two to three years or will adapt to the abnormality. Severe ophthalmopathy will affect 10% of patients. It is caused by inflammation of the muscles, which causes them to swell.
How do you test for Graves ophthalmopathy?
A diagnosis of Graves' orbitopathy is clinical. Thyroid function studies can be helpful, but in some cases are normal. To determine if Graves' orbitopathy is present, your doctor may require more scans, such as a computerized tomography (CT) scan or MRI, to identify changes in the muscles around the eyes.
How to correct Graves ophthalmopathy?
Eyelid surgery is the most common surgery performed on Graves ophthalmopathy patients. Lid-lengthening surgeries can be done on upper and lower eyelid to correct the patient's appearance and the ocular surface exposure symptoms. Marginal myotomy of levator palpebrae muscle can reduce the palpebral fissure height by 2–3 mm. When there is a more severe upper lid retraction or exposure keratitis, marginal myotomy of levator palpebrae associated with lateral tarsal canthoplasty is recommended. This procedure can lower the upper eyelid by as much as 8 mm. Other approaches include müllerectomy (resection of the Müller muscle ), eyelid spacer grafts, and recession of the lower eyelid retractors. Blepharoplasty can also be done to debulk the excess fat in the lower eyelid.
What is the most common ocular sign of Graves' orbitopathy?
In mild disease, patients present with eyelid retraction. In fact, upper eyelid retraction is the most common ocular sign of Graves' orbitopathy. This finding is associated with lid lag on infraduction ( Von Graefe's sign ), eye globe lag on supraduction ( Kocher's sign ), a widened palpebral fissure during fixation ( Dalrymple's sign) and an incapacity of closing the eyelids completely ( lagophthalmos, Stellwag's sign ). Due to the proptosis, eyelid retraction and lagophthalmos, the cornea is more prone to dryness and may present with chemosis, punctate epithelial erosions and superior limbic keratoconjunctivitis. The patients also have a dysfunction of the lacrimal gland with a decrease of the quantity and composition of tears produced. Non-specific symptoms with these pathologies include irritation, grittiness, photophobia, tearing, and blurred vision. Pain is not typical, but patients often complain of pressure in the orbit. Periorbital swelling due to inflammation can also be observed.
What is Graves' disease?
Ophthalmology. Graves’ ophthalmopathy, also known as thyroid eye disease ( TED ), is an autoimmune inflammatory disorder of the orbit and periorbital tissues, characterized by upper eyelid retraction, lid lag, swelling, redness ( erythema ), conjunctivitis, and bulging eyes ( exophthalmos ). It occurs most commonly in individuals ...
What causes a swollen eye and skin?
It is part of a systemic process with variable expression in the eyes, thyroid, and skin, caused by autoantibodies that bind to tissues in those organs .
Why are eyes situated at different levels?
Eyes seem to be situated at different levels because of tanned skin. John Dixon Mann, English pathologist and forensic scientist (1840–1912) Mean sign. Increased scleral show on upgaze (globe lag) Named after the expression of being "mean" when viewed from afar, due to the scleral show.
Who was the first to describe the association of a thyroid goitre with exophthalmos (proptos?
In medical literature, Robert James Graves , in 1835, was the first to describe the association of a thyroid goitre with exophthalmos (proptosis) of the eye. Graves' ophthalmopathy may occur before, with, or after the onset of overt thyroid disease and usually has a slow onset over many months.
Can orbital fat cause optic nerve damage?
The orbital fat or the stretching of the nerve due to increased orbital volume may also lead to optic nerve damage. The patient experiences a loss of visual acuity, visual field defect, afferent pupillary defect, and loss of color vision. This is an emergency and requires immediate surgery to prevent permanent blindness.
How many eyes does Graves' disease affect?
Most of the time, Graves’ eye disease affects both eyes. About 15 percent of the time, only one eye is involved. Hiromatsu Y, et al. (2014). Graves’ ophthalmopathy: Epidemiology and natural history.
What is Graves disease?
Graves’ disease is an autoimmune disorder that causes your thyroid gland to produce more hormones than it should. Overactive thyroid is called hyperthyroidism. Among the potential symptoms of Graves’ disease are irregular heartbeat, weight loss, and an enlarged thyroid gland ( goiter ). Sometimes, the immune system attacks tissues ...
What are the risk factors for Graves disease?
Risk factors for GO include: genetic influences. smoking. iodine therapy for hyperthyroidism. You can develop Graves’ disease at any age, but most people are between the ages of 30 and 60 at diagnosis. Graves’ disease affects about 3 percent of women and 0.5 percent of men. Graves’ disease. (2017).
Why do my eyes bulge out?
Sometimes, the immune system attacks tissues and muscles around the eyes. This is a condition called thyroid eye disease or Graves’ ophthalmopathy (GO). Inflammation causes the eyes to feel gritty, dry, and irritated. This condition can also make your eyes appear to bulge out. Graves’ eye disease affects between 25 and 50 percent ...
How to fix double vision?
Be sure to tell your doctor if nothing is working and you continue to have double vision, decreased vision, or other problems. There are some surgical interventions that can help, including: 1 Orbital decompression surgery to enlarge the eye socket so the eye can sit in a better position. This involves removing a bone between the eye socket and sinuses to create space for swollen tissue. 2 Eyelid surgery to return the eyelids to a more natural position. 3 Eye muscle surgery to correct double vision. This involves cutting muscle affected by scar tissue and reattaching it further back.
How long does it take for Graves' eye to stabilize?
Eye symptoms usually stabilize after about six months. They may start to improve right away or remain stable for a year or two before they start to improve. Graves’ eye disease can be successfully treated, and symptoms often improve even without treatment. Last medically reviewed on February 21, 2019.
How long does Graves' disease last?
There’s a period of active inflammation in which symptoms worsen. This can last up to six months or so. Then there’s an inactive phase in which symptoms stabilize or start to improve.
WHAT ARE THE SYMPTOMS OF GRAVES OPHTHALMOPATHY?
Eye symptoms most often begin within 6 months of diagnosis of Graves’ disease. Very rarely eye problems may develop long after the thyroid disease has been treated. In some patients with eye symptoms, hyperthyroidism never develops and, rarely, patients may be hypothyroid. The severity of the eye symptoms is not related to the severity of the hyperthyroidism.
What is Graves' eye disease?
Graves’ eye disease, also called Graves’ Ophthalmopathy or Thyroid Eye disease, is a problem that usually develops in people with an overactive thyroid caused by Graves’ disease (See brochure on Graves’ disease ). Graves’ disease is an autoimmune disease caused by antibodies directed against receptors present in the thyroid cells and also on the surface of the cells behind the eyes. Rarely can also affect the skin, usually the front part of the legs. This usually results in a generalized over activity of the thyroid gland (hyperthyroidism). Up to one-half of people with Graves’ disease develop eye symptoms. These are usually mild and treatable.
HOW IS THE DIAGNOSIS MADE?
If you have already been diagnosed with hyperthyroidism, a doctor may diagnose Graves’ eye disease by examining your eyes and finding swelling and enlargement of the eye muscles. A computed tomography (CT) scan or magnetic resonance imaging (MRI) scan of the eye muscles may be helpful. Graves’ disease usually is associated with other symptoms of overactive thyroid. However, the classic symptoms of hyperthyroidism may not always be present. In fact, Graves’ eye disease can occur even when the thyroid is not overactive at that time.
Where is the thyroid gland located?
The thyroid gland is a butterfly-shaped endocrine gland that is normally located in the lower front of the neck. The thyroid’s job is to make thyroid hormones, which are secreted into the blood and then carried to every tissue in the body. Thyroid hormone helps the body use energy, stay warm and keep the brain, heart, muscles, and other organs working as they should.
What is orbital decompression surgery?
Orbital Decompression Surgery. When eyesight is threatened, a type of surgery called orbital decompression can be done. In this procedure, a bone between the eye socket (orbit) and sinuses is removed to allow more space for the swollen tissues. When the procedure is successful, it improves vision and provides room for your eyes to return to their normal position. There is a risk of complications, including double vision that persists or appears after surgery.
What is the best treatment for swelling in the eye?
Steroids. Swelling in the eyes may be improved by treatment with steroids (such as hydrocortisone or prednisone)
Can Graves' eye disease be caused by thyroid?
Graves’ disease usually is associated with other symptoms of overactive thyroid. However, the classic symptoms of hyperthyroidism may not always be present. In fact, Graves’ eye disease can occur even when the thyroid is not overactive at that time. Graves’ eye disease often improves on its own. However, in some patients symptoms may persist ...
What is Graves' Eye Disease (Graves' Ophthalmopathy)?
Graves' eye disease, also called Graves' ophthalmopathy, is a problem that develops in people with an overactive thyroid caused by Graves' disease. Up to one-half of people with Graves' disease develop eye symptoms. Usually the eye symptoms are mild and easily treated.
What is the most common surgery for Graves' eye disease?
The most common surgery for Graves' eye disease is eyelid surgery to reposition the eyelid. In addition, surgery on the eye muscles can be done to realign the eyes. These procedures are performed by an eye specialist called an ophthalmologist.
How to diagnose Graves disease?
If you already have been diagnosed with Graves' disease, a doctor may diagnose eye disease by examining your eyes and finding swelling and enlargement of the eye muscles. A computed tomography (CT) scan or magnetic resonance imaging (MRI) scan of the eye muscles may be helpful. Graves' disease usually is associated with other symptoms ...
What is the best treatment for Graves' eye?
A corticosteroid drug, taken by mouth or intravenously, is the main therapy for Graves' eye disease. Oral prednisone is used most often when eye bulging and swelling continue to get worse. High dose prednisone or an intravenous corticosteroid is used if there is compression of the optic nerve. This is the most serious complication ...
Why do people with Graves' eye disease sleep with their heads elevated?
People with Graves' eye disease often are advised to sleep with their heads elevated to reduce eyelid swelling. If double vision is a continuing problem, glasses containing prisms may be prescribed or surgery on the muscles may be advised.
Why is the bone between the eye socket and sinuses removed?
In this procedure, a bone between the eye socket (orbit) and sinuses is removed to allow more space for the swollen tissues. This more complicated operation requires a medical center with expertise in this area. It is important that thyroid blood levels be maintained in the normal range.
Does Graves' eye disease improve on its own?
Graves' eye disease often improves on its own. But symptoms may persist despite treatment of the overactive thyroid gland and specific eye therapies.
What causes Graves' ophthalmopathy?
Cause of Graves' ophthalmopathy. Graves' ophthalmopathy results from a buildup of certain carbohydrates in the muscles and tissues behind the eyes — the cause of which also isn't known. It appears that the same antibody that can cause thyroid dysfunction may also have an "attraction" to tissues surrounding the eyes.
What is Graves disease?
Graves' disease is an immune system disorder that results in the overproduction of thyroid hormones (hyperthyroidism). Although a number of disorders may result in hyperthyroidism, Graves' disease is a common cause. Thyroid hormones affect many body systems, so signs and symptoms of Graves' disease can be wide ranging.
What are the symptoms of Graves disease?
Graves' ophthalmopathy signs and symptoms include bulging eyes, redness and retracting eyelids. About 30% of people with Graves' disease show some signs and symptoms of Graves' ophthalmopathy. In Graves' ophthalmopathy, inflammation and other immune system events affect muscles and other tissues around your eyes.
Why does Graves disease happen?
Graves' disease is caused by a malfunction in the body's disease-fighting immune system. It's unknown why this happens.
Where does Graves disease occur?
It often occurs on the shins and on the tops of the feet. An uncommon manifestation of Graves' disease, called Graves' dermopathy, is the reddening and thickening of the skin, most often on your shins or the tops of your feet.
Can Graves' ophthalmopathy be seen before or after hyperthyroidism?
But signs and symptoms of ophthalmopathy may appear years before or after the onset of hyperthyroidism. Graves' ophthalmopathy can also occur even if there's no hyperthyroidism.
When does Graves disease develop?
Graves' disease usually develops in people before age 40. Other autoimmune disorders. People with other disorders of the immune system, such as type 1 diabetes or rheumatoid arthritis, have an increased risk. Emotional or physical stress.
What is Graves' orbitopathy?
Graves' orbitopathy is an autoimmune condition characterized by swelling of the tissue in the orbit (the area around the eyes), creating bulging of the eyes . It is associated with Graves' disease, which causes over activity of the thyroid gland (which sets the rate of metabolism in the body). Diagnosis of Graves' orbitopathy is made by an ophthalmologist.
How is Graves' orbitopathy diagnosed?
To determine if Graves' orbitopathy is present, your doctor may require more scans, such as a computerized tomography (CT) scan or MRI, to identify changes in the muscles around the eyes.
What is orbital decompression surgery?
Orbital decompression surgery to remove bone between the areas around the eyes (orbits) and the sinuses to create more space for swollen muscles
What is Graves disease?
Graves’ disease is an autoimmune disease that affects the thyroid gland. The gland produces too much thyroid hormone, a condition known as hyperthyroidism. Thyroid hormones regulate body temperature, heart rate and metabolism. An overactive thyroid causes problems with organs like the heart, as well as bones and muscles. Treatments can help.
What test is used to diagnose Graves disease?
You may also have these tests to confirm a Graves’ disease diagnosis: Blood test: Thyroid blood tests measure TSI, an antibody that stimulates thyroid hormone production. Blood tests also check amounts of thyroid-stimulating hormones (TSH). A low TSH level indicates that the thyroid gland is producing too much hormone.
What is the butterfly gland in the neck?
This butterfly-shaped gland in the neck produces hormones that regulate how your body uses energy (metabolism). Graves’ disease is the most common cause of hyperthyroidism (overactive thyroid gland). People with Graves’ disease make too much thyroid hormone, which can damage the heart and other organs. The condition gets its name ...
What age does Graves disease occur?
It typically occurs in people between the ages of 30 and 50. The condition tends to run in families. Your risk of developing Graves’ disease increases if you have: Family history of thyroid disease. Another autoimmune disease, such as rheumatoid arthritis, lupus or Type 1 diabetes. Celiac disease.
What causes a bulging eye?
Untreated or poorly managed Graves’ disease increases your risk for these complications: Eye disease: Thyroid eye disease, or Graves’ ophthalmopathy, occurs when the immune system attacks muscle and tissue around the eyes. Inflammation causes the eyes to protrude or bulge.
How many people have Graves disease?
Graves’ disease affects one out of every 200 Americans, making it the top cause of hyperthyroidism.
Does Graves disease go away?
Graves’ disease is a lifelong condition. However, treatments can keep the thyroid gland in check. Medical care may even make the disease temporarily go away (remission): Beta-blockers: Beta-blockers, such as propranolol and metoprolol, are often the first line of treatment. These medications regulate your heart rate and protect your heart ...
Overview
Graves’ ophthalmopathy, also known as thyroid eye disease (TED), is an autoimmune inflammatory disorder of the orbit and periorbital tissues, characterized by upper eyelid retraction, lid lag, swelling, redness (erythema), conjunctivitis, and bulging eyes (exophthalmos). It occurs most commonly in individuals with Graves' disease, and less commonly in individuals with Hashimoto's thyroiditis, or in those who are euthyroid.
Signs and symptoms
In mild disease, patients present with eyelid retraction. In fact, upper eyelid retraction is the most common ocular sign of Graves' orbitopathy. This finding is associated with lid lag on infraduction (Von Graefe's sign), eye globe lag on supraduction (Kocher's sign), a widened palpebral fissure during fixation (Dalrymple's sign) and an incapacity of closing the eyelids completely (lagophthalmos, Stellwag's sign). Due to the proptosis, eyelid retraction and lagophthalmos, the c…
Pathophysiology
TAO is an orbital autoimmune disease. The thyroid-stimulating hormone receptor (TSH-R) is an antigen found in orbital fat and connective tissue, and is a target for autoimmune assault.
On histological examination, there is an infiltration of the orbital connective tissue by lymphocytes, plasmocytes, and mastocytes. The inflammation result…
Diagnostic
Graves' ophthalmopathy is diagnosed clinically by the presenting ocular signs and symptoms, but positive tests for antibodies (anti-thyroglobulin, anti-microsomal and anti-thyrotropin receptor) and abnormalities in thyroid hormones level (T3, T4, and TSH) help in supporting the diagnosis.
Orbital imaging is an interesting tool for the diagnosis of Graves' ophthalmopathy and is useful in monitoring patients for progression of the disease. It is, however, not warranted when the diagn…
Prevention
Not smoking is a common suggestion in the literature. Apart from smoking cessation, there is little definitive research in this area. In addition to the selenium studies above, some recent research also is suggestive that statin use may assist.
Treatment
Even though some people undergo spontaneous remission of symptoms within a year, many need treatment. The first step is the regulation of thyroid hormone levels. Topical lubrication of the eye is used to avoid corneal damage caused by exposure. Corticosteroids are efficient in reducing orbital inflammation, but the benefits cease after discontinuation. Corticosteroids treatment is also limited because of their many side effects. Radiotherapy is an alternative option to reduce a…
Prognosis
Risk factors of progressive and severe thyroid-associated orbitopathy are:
• Age greater than 50 years
• Rapid onset of symptoms under 3 months
• Cigarette smoking
• Diabetes
Epidemiology
The pathology mostly affects persons of 30 to 50 years of age. Females are four times more likely to develop TAO than males. When males are affected, they tend to have a later onset and a poor prognosis. A study demonstrated that at the time of diagnosis, 90% of the patients with clinical orbitopathy were hyperthyroid according to thyroid function tests, while 3% had Hashimoto's thyroiditis, 1% were hypothyroid and 6% did not have any thyroid function tests abnormality. Of p…
What Is Graves' Eye Disease (Graves' Ophthalmopathy)?
Symptoms
- Symptoms of Graves' eye disease include: 1. Early symptoms— Feeling of irritation in the eyes, excessive tearing or dry eye, forward displacement of the eye, sensitivity to light and double vision 2. Late symptoms— Swelling of the eye, inability to move the eye, corneal ulceration, and, rarely, loss of vision
Diagnosis
- If you already have been diagnosed with Graves' disease, a doctor may diagnose eye disease by examining your eyes and finding swelling and enlargement of the eye muscles. A computed tomography (CT) scan or magnetic resonance imaging (MRI) scan of the eye muscles may be helpful. Graves' disease usually is associated with other symptoms of overactive thyroid. Howev…
Expected Duration
- Graves' eye disease often improves on its own. But symptoms may persist despite treatment of the overactive thyroid gland and specific eye therapies.
Prevention
- Graves' disease cannot be prevented. And usually, the associated eye disease cannot be prevented. However, medical evidence now suggests that treatment of the overactive thyroid gland with radiation therapy is more likely to worsen the eye disease. If radiation of the thyroid must be done, some studies suggest that patients with hyperthyroidism from Graves' disease w…
Treatment
- In mild cases, cool compresses, sunglasses and artificial tears provide relief. People with Graves' eye disease often are advised to sleep with their heads elevated to reduce eyelid swelling. If double vision is a continuing problem, glasses containing prisms may be prescribed or surgery on the muscles may be advised. If the thyroid gland is overactive, anti-thyroid medications, radiatio…
When to Call A Professional
- Call your doctor if you notice any changes in the appearance of your eye or if you develop any of the symptoms of Graves' eye disease.
Further Information
- Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. Medical Disclaimer