Clinical Thyroidology® for the Public

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Eye surgery for thyroid eye disease and quality of life

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Graves’ disease is an autoimmune condition that affects thyroid function and causes hyperthyroidism. This occurs when the body develops antibodies that attack and turn on the thyroid. These antibodies are known as thyroid stimulating immunoglobulins, or TSI. Approximately 30-50% of patients may also develop an associated condition that affects the eyes, known as thyroid eye disease, or Graves’ Ophtalmopathy. However, only a relatively small percentage of patients with thyroid eye disease develop significant symptoms. These symptoms can include burning, itching, increasing tearing, double vision and decreased vision. The most severe symptom is inflammation of the eye muscles that causes bulging of the eyes that can alter a patient’s appearance. Risk factors for developing thyroid eye disease include female sex, smoking, having been treated with radioactive iodine, elevated TSI, and, possibly, the duration and severity of hyperthyroidism.

The symptoms of thyroid eye disease can be severe and affect quality of life in many ways. The treatments available at this time depend on the severity of the eye disease and include eye drops, eye patches, medications to decrease muscle inflammation, treatment of the hyperthyroidism, external radiation to the eye muscles and surgery. There are different types of surgeries that are offered that may include eyelid surgery, eye muscle surgery to correct double vision and surgery of the eye sockets to make more room for the inflamed eye muscles.

This study was done by reviewing and analyzing existing studies to help assess whether the different types of eye surgery improved the quality of life in patients with thyroid eye disease.

Woo T et al P 2022 The effect of ophthalmic surgery for Graves’ orbitopathy on quality of life: A systematic review and meta-analysis. Thyroid 32:177–187. PMID: 34877883.

The authors analyzed data from 10 studies which included a total of 632 patients, with a mean age of 48.4 years. The instrument used was the Graves’ Ophtalmopathy Quality of Life questionnaire. The results of this analysis suggest that eye surgery is associated with improved quality of life in regards to appearance but also in regards to visual function.

For improvement in appearance, surgery of the eye sockets had the most improvement, followed by eyelid surgery. Overall surgery of the eye sockets resulted in improved appearance and eye muscle surgery improved function and appearance, while eyelid surgery improved only eye appearance.

Thyroid eye disease can be highly debilitating and have substantial long-term negative connotations for patients’ wellbeing and quality of life. This study showed that surgery can improve quality of life in these patients, but the type of surgery chosen impacts different aspects of quality of life.

Importantly, there is a new medical treatment that has shown to be very effective, so future studies should include evaluation of quality of life in patients treated with this new medication.

— Jessie Block-Galarza, MD


Thyroid Eye Disease: Also known as Graves Ophtalmopathy. TED is most often seen in patients with Graves’disease but can also be seen in patients with Hashimoto’s thyroiditis. TED includes inflammation of the eyes, eye muscles and the surrounding tissues. Symptoms include dry eyes,red eyes, bulging of the eyes and double vision.

Autoimmune thyroid disease: a group of disorders that are caused by antibodies that get confused and attack the thyroid. These antibodies can either turn on the thyroid (Graves’ disease, hyperthyroidism) or turn it off (Hashimoto’s thyroiditis, hypothyroidism).

Graves’ disease: the most common cause of hyperthyroidism in the United States. It is caused by antibodies that attack the thyroid and turn it on.

August-Thyroid and Pregnancy Awareness Month