Autoimmune hyperthyroidism is the most common autoimmune disease in the USA. It is an inflammatory autoimmune disease with an unclear mechanism. Between 25 and 50% of these patients will develop thyroid eye disease. The eye is susceptible to attack because the autoantibodies target common receptors found within the thyroid gland, eye, and skin. Thyroid eye disease is identified based on clinical signs, supported with laboratory studies, and imaging.

Thyroid eye disease is the leading cause of bilateral proptosis (eye bulging), lid retraction (eyelid malpositioning), and double vision in adults. It may be associated with a goiter, skin inflammation, bowing of nails, and even congestive heart failure. Fluctuations in thyroid status may aggravate thyroid eye disease leading to permanent changes in appearance and vision loss.

In the eye, this disease may lead to fat expansion, muscle expansion, or both. Early detection is key because muscle expansion is a permanent change that cannot be fixed with medications and surgery.

Thyroid eye disease is often described by an active or inflammatory phase followed by a stable phase. Although the disease course limits itself between 6 months to 2 years, it is often a roller coaster of exacerbation and remissions. The disease course is independent of thyroid function so it is important to follow up with your endocrinologist early.

In other words, there is a point of no return: once you get thyroid eye disease, despite control of your thyroid by your endocrinologist, signs or symptoms in the eye may continue to worsen. If identified, mild thyroid eye disease is often followed on a 3 to 6-month basis and symptoms of discomfort are treated. If the disease progresses, referral to an ophthalmologist specializing in oculoplastics is warranted with monthly follow-up.

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