What is thyroid eye disease?
Thyroid eye disease can occur as a result of Graves’s disease, or hyperthyroidism and much less frequent as hypothyroidism. Infiltration of the muscles and tissues surrounding the eye can cause poor eye movement, proptosis, or bulging of the eyes, eyelid malpositioning, and visual loss. Patients can present with a single eyelid retraction, or mild proptosis, or have a dramatic change in their appearance, which can also be a sight-threatening disease if not treated correctly. Thyroid disease and other autoimmune diseases can be physically and emotionally debilitating to the patient.
A recent development in the medical treatment for thyroid eye disease is the new FDA-approved medication, Tepezza (Teprotumumab). In early 2020, this mediation was FDA approved to treat thyroid eye disease with fewer side effects than currently available agents. Tepezza works by blocking the immune response of active thyroid eye disease by inhibiting IGF-IR and thyrotropin receptors. A recent phase 3 trial in 41 patients demonstrated improvement of proptosis (bulging of the eyes) of 2mm or more and reduction in diplopia (double vision), as well as an overall lower clinical activity score and improvement of QOL (quality of life).
Patients typically undergo eight intravenous infusions over 24 weeks. Side effects have been reported to be mild to moderate, including muscle spasms (32%), alopecia (20%), fatigue (12%) and diarrhea, headache (10%) and hyperglycemia. Monitoring is recommended.
Currently, it can take several weeks for approval of this medication for patients with a diagnosis of thyroid eye disease and proptosis. Dr. Amato and her team can evaluate patients to see if they are eligible, then begin the approval process to institute treatment at an infusion center. She and her team coordinate care with eye doctors, endocrinologists, and rheumatologists to treat and safely monitor patients as she follows their ophthalmic response.
Contact Dr. Amato today to see if you are eligible by calling 512-501-1010. For more information, visit my website at http://www.malenaamatomd.com.
How do you treat thyroid eye disease?
Management of patients with this disease is often multidisciplinary and includes endocrinologists, rheumatologists, internists, ophthalmologist, strabismus surgeons, and oculoplastic surgeons. Patients with mild eye symptoms may be monitored and treated with lubricating eye drops or ointment for comfort and oral supplements. Patients with severe sight-threatening progression of the disease often require high-dose steroid or other immunosuppression treatment, radiation therapy or surgery to decompress the eye and preserve sight.
For more information, visit www.asoprs.org
What is the surgery for thyroid eye disease?
The surgery to correct sequela of thyroid eye disease can vary from eyelid retraction surgery to orbital decompression. Surgery is usually outpatient or overnight stay and can take a few hours per eye. Patients may also require surgery to straighten the muscles that move the eye and eyelid surgery to remove extra tissue.
Meet Malena Amato MD FACS
Learn more about the Georgetown and Stanford alumna and why you should visit Dr. Amato for your next procedure.
What is the recovery process for surgery after thyroid orbital decompression?
This process of eye and orbit rehabilitation after a diagnosis of thyroid eye disease can take years, but the majority of the post-operative bruising and swelling will occur for the next weeks after surgery. Dr. Amato and the team of specialists work closely together and are there to explain the process to you and help you through it every step of the way. Other autoimmune disorder can cause eyelid inflammation including inflammatory orbital syndrome, IgG4 inflammation, and others. For more information, refer to Graves Eye Disease, American Thyroid organization or www.thyroid.org.