Read the reasons why you should see an ophthalmologist if you recognize some of these symptoms or signs, and January, as thyroid disease awareness month, is the perfect time to do so.
Piše: Nina Jovanović, Mr. sc.med.dr, MPH
January is the month of thyroid disease awareness, preventive examination, and early detection of thyroid disease to avoid unpleasant symptoms and dangerous complications. Thyroid diseases are the most widespread health problem worldwide, affecting millions of people, especially in the generative and most productive age of life. This disorder often goes unnoticed by doctors who do not deal with this pathology. It is not uncommon for us to see a patient during an examination with all the signs and symptoms of silent or acute thyroid disease that only affects the eye and the structures behind the eye. Then we suspect that it is an autoimmune form of thyroid disease that often only affects the eyes and the tissues behind the eye.
It is not enough to just have normal hormones (T3 and T4) to say that eye protrusion, constant stinging, dryness, tearing, or a widening of the eye-opening has nothing to do with the thyroid gland. It is necessary to perform additional diagnostics of antibodies, ultrasound of the orbit, or MRI to fully differentiate what kind of therapy is needed. In this sense, we perform tests for antibodies that can diagnose autoimmune thyroid diseases, namely Hashimoto's disease or chronic lymphocytic thyroiditis, which leads to weaker thyroid function, or Graves' disease, which causes increased thyroid function (hyperthyroidism).
Nina Jovanović, Mr. sc.med.dr, MPH
In this disorder, there is the creation of antibodies directed at TSH receptors that are located on the surface of thyroid cells, and in which signs of the disease, such as "bulging eyes" (exophthalmos), impaired eye movement, persistent swelling of the eyelids, redness of the eye, strabismus, and spectrum may appear. subjective sensations such as dryness, blistering of the eye, increased tearing, double images, and a feeling of heaviness of the eyelids. The most severe form of the disease is the stage when the enlarged muscles and tissues behind the eye put pressure on the optic nerve, which can consequently lead to loss of central vision or exposure of the cornea leading to ulcers or perforations. However, even these most severe forms can be successfully treated if they are recognized in time.
It is important to emphasize that the concentration of antibodies in the blood of patients changes and tells us about the dynamics of the disease, so that often patients have normal laboratory values of antibodies for a while, which speaks in favor of a quiet phase of the disease, and then the disease can be activated again, which is usually accompanied by elevated values of antibodies. The antibodies tested are TSH-R-Ab (ATRAb antibodies), TSI (thyroid-stimulating immunoglobulin), and ATPO antibodies. Ultrasound (A- and B-scan) is used to assess the thickness and shape of the extraocular muscles.
Risk factors include female gender (5 times higher risk than men), age over 40, radioactive iodine (often used to treat thyroid disease), positive family history, active or passive smoking (tobacco smoke increases the risk of TED 8 times), vitamin D3 deficiency, and unregulated thyroid hormone values
Eye protrusion, stinging, and dry eyes can be signs of thyroid disease.
The phase in which the patient experiences these subjective complaints and we notice signs of the disease is called active and usually lasts from 6 months to 3 years, and then drug therapy is prescribed. Most often, artificial tears, selenium, vitamin D3, and corticosteroids are prescribed, and occasionally radiotherapy or cyclosporine. Currently, a revolutionary drug, Teprotumamab, is registered on the US market, a monoclonal antibody that inhibits the insulin-like growth factor receptor (IGF-IR) and is prescribed in the acute, inflammatory phase of this disease. After the acute phase, the symptoms and signs of the disease subside, and a quiet phase begins in which protrusion, strabismus, double vision, heaviness, and retraction of the eyelids often remain. At this stage of the disease, surgical procedures are usually planned in the following order:
In a large number of patients, the quiescent phase lasts a lifetime without recruitment. All of these are reasons why you should see an ophthalmologist if you recognize any of these symptoms or signs in yourself, and January, Thyroid Disease Awareness Month, is the perfect time to do so.(http://dobardan.ba/)
English
Bosanski
