Thyroid Eye Disease Surgery

Thyroid eye disease is caused by an autoimmune disorder that affects the thyroid gland. In this disorder, the immune system creates antibodies that mistakenly attack the thyroid gland, causing it to produce increased thyroid hormones. Thyroid hormones control many different bodily functions.

Overproduction of thyroid hormones leads to a condition called ‘hyperthyroidism’. Symptoms of hyperthyroidism can include weight loss, rapid heartbeat, and anxiety. These antibodies also interfere with the tissue around the eyes, causing swelling, inflammation and scarring. This is known as thyroid eye disease.

While most people with thyroid eye disease have hyperthyroidism, there are also some people with thyroid eye disease who have normal or low thyroid function.

Radioactive iodine treatment of the thyroid gland has been linked to triggering or worsening of thyroid eye disease in some people. If you have thyroid eye disease, this treatment is not routinely recommended. If it is undertaken, corticosteroids are sometimes given at the time of radioactive iodine treatment and may help to prevent flare-ups of thyroid eye disease. Your endocrinologist can explain this further.

Symptoms of thyroid eye disease include inflammation and swelling of the eyelids, eye muscles, and fat in the eye socket, leading to bulging of the eyes, a feeling of pressure behind the eyes, tearing, redness, and swelling of the eyelids. The swelling of the eye muscles can also cause double vision and retraction of the eyelids, giving the appearance of staring.

In severe cases, pressure in the eyes can increase, causing glaucoma. In very severe, vision threatening disease, the eyelids may not close, which risks infection. The optic nerve connecting the eye to the brain may become compressed and damaged.

Diagnosis of thyroid eye disease is made by an experienced doctor. No single test determines whether you have thyroid eye disease. Diagnosis may involve taking a blood test to check thyroid function and antibodies.

Other conditions that can mimic thyroid eye disease may also be tested for.

CT or MRI imaging of the eye socket may be helpful in confirming the diagnosis and assessing the extent of eye muscle and fat swelling.

Unfortunately, there is no ‘cure’ for thyroid eye disease. The inflammation associated with thyroid eye disease often escalates over 6 to 12 months, before spontaneously improving over 12 to 18 months. Medication or radiotherapy can be used to reduce this inflammation. (This is different to radioactive iodine.)

Whether treatment is recommended depends on the level of your symptoms and many other factors. After the inflammation settles, the signs of thyroid eye disease may persist but usually do not fully resolve. You may still have eye protrusion, stiffness of the eye muscles, eyelid retractions, and bags around your eyes. These problems may require surgical correction.

Treatment options for mild thyroid eye disease include

In moderate to severe thyroid eye disease, intravenous corticosteroids are the first-line treatment.

If the swelling in the eye socket is compressing the optic nerve, loss of vision may occur, and urgent, high dose intravenous corticosteroids are required. Surgery may also be recommended.

Newer treatments involving immune-modulating drugs are also being trialled however are limited in their availability.

Antithyroid medications and thyroid removal surgery can help but they do not cure thyroid eye disease.

Dr Parker routinely performs surgery for patients with thyroid eye disease and understands that living with this condition can be challenging. For best results, Dr Parker often recommends a staged approach to thyroid eye disease surgery. Not all patients need all of these procedures and Dr Parker will discuss your individual needs with you at the time of your consultation and follow up.

If your eyes are significantly protruding this needs to be dealt with first. Reduction in protrusion can be achieved through a procedure called orbital decompression, where bones around the eye socket are removed in a graduated fashion to make space for the swollen tissues. In some cases, fat may also be removed to further reduce exophthalmos.

If you have severe double vision due to restriction of the eye muscles, Dr Parker may recommend squint surgery. This is usually performed after orbital decompression by a specialist in squint surgery.

Swelling and scarring of the eyelids may have stretched the skin, leading to drooping eyelids, fat protrusion around the eyes or continued retraction of the eyelids. For people with thyroid eye disease, Dr. Parker may recommend eyelid lowering or elevation surgery to correct abnormalities of eyelid height. Sometimes spacer material may be used. He may also recommend simultaneous upper and/or lower eyelid reduction, which is performed by removing excess eyelid skin, muscle and fat tissue in a graded fashion to achieve the optimum eyelid height and contour.

These eyelid corrections are all considered medically necessary procedures, not cosmetic procedures, and attract rebates from Medicare and private health funds.