What is Thyroid Ophthalmopathy? How is it treated?
THYROID OPHTHALMOPATHY
Thyroid ophthalmopathy is an eye disease that often occurs because of thyroid dysfunction. Graves's disease is a condition of autoimmune (a condition where the immune system accidentally attacks the normal tissues of the body) characterized by hyperthyroidism, goiter, ophthalmopathy, and, in rare cases, dermopathies. The most common extra-thyroid symptom of Graves' disease is thyroid ophthalmopathy.
In addition to high levels of free thyroid hormone and suppressed thyroid stimulating hormone (TSH) levels, levels of serum anti-thyroglobulin (TG) antibodies, antithyroid peroxidase (anti-TPO), and TSH receptor antibody can also be elevated in Graves's disease.
The reactive lymphocytes (immune system leucocytes) that recognize the common thyroid antigens in orbit leak into orbit and the extraocular muscles. This is reinforced by circulating and local adhesive molecules stimulated by cytokines.
Studies in recent years have shown that auto-thyroid antibodies and immune system genes play an important role in predicting before ophthalmopathy develops and determining its severity after it begins. Anti-TPO antibody and anti-TG positive rates in the presence of ophthalmopathy were at 90% and 50% respectively.
Following the infiltration of the lymphocytes in the orbit, the orbital fatty tissue increases in volume and hardens. The eye movements begin to lose freedom, the eyeballs begin to clog into the orbit.
During the infiltration period, eye movements are restricted due to edema in the ocular muscles and subsequent fibrosis. Double vision is common with the appearance of consecutive upward images. Daily activities are affected in the primary position (straight look) and reading positions. The eyes start to spread, sight problems, double vision (diplopia), and other complaints.
Optical neuropathy (affliction and destruction of the optic nerve) develops as a result of the pressure of the enlarged muscles on the optical nerves or on the vessels that feed it. A gradual decrease in visual acuity, color vision impairment, and blind spaces around or in the center of the visual field can occur.
If not treated, all complaints (some irreversibly) become worse over time.
Treatment of thyroid ophthalmopathy
The first treatment option should be intravenous and then oral steroid therapy and other medical treatments. If these are not sufficient or in cases that have passed this stage, surgical treatment is performed. The surgical treatment of thyroid ophthalmopathy is decompression surgery. The purpose of decompression surgery is to reduce the apical pressure as much as possible by increasing the orbital volume. The most commonly used technique is the removal of the inner and outer walls of the orbit by refreshing the orbital contents out of orbit. In severe cases, decompression is also applied to other orbital walls.