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thyroid 12.16.03 AM - Institute of Ophthalmology Thyroid...

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Thyroid Eye Disease aka Thyroid Associated Ophthalmopathy Institute of Ophthalmology
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Causes TED/TAO is an eye disease associated with disease of the thyroid gland Most commonly, it occurs with an overactive thyroid (Thyrotoxicosis), which itself can have different causes: Grave’s disease Toxic nodular goitre It also occurs in hypothyroidism, for example with Hashimoto’s disease
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Grave’s disease Autoimmune (AI) origin Excess secretion of Thyroid Hormone by entire gland Majority occurs between 40s and 50s Female:Male = 8:1 Affect 2% of females in UK, hence the commonest clinically significant AI disease in the community
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In patients with Grave’s disease, eye signs may precede, coincide with or follow the hyperthyroidism Sometimes similar eye signs are seen without a detectable thyroid abnormality
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Pathology Activated T cells infiltrate orbital contents and stimulate fibroblasts, leading to: 1.Enlargement of extraocular muscles 2.Cellular infiltration of interstitial tissues 3.Proliferation of orbital fat and connective tissue
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Enlargement of extraocular muscles The stimulated fibroblasts produce glycosaminoglycans (GAGs) which cause the muscle to swell Muscle size may increase by up to 8 times The swollen muscles occupy orbital space and can compress the optic nerve These swollen muscles can cause a forward propulsion of the globe (proptosis) so that the eyelids do not cover well and eyes dry out, causing exposure keratopathy Swollen muscles Compression of optic nerve at apex of orbit Swollen muscle (lateral rectus) Swollen muscle (medial rectus)
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