Dysthyroid Eye Disease

This is an auto-immune disease of the eye socket and eye muscles and occurs in those with thyroid disease. Characterized by inflammation, swelling and eventual scarring, thyroid eye disease is a rare condition affecting about 16 women in every 100,000 people and 3 men in every 100,000 persons every year.

Overactive thyroid gland or hyperthyroidism and an underlying autoimmune condition that occurs in middle age are the cause. This could also be hereditary. Smoking could be another reason. Studies reveal that almost 40 percent of those with Graves disease develop Dysthyroid eye disease. This could also occur in those with hypothyroidism, Hashimoto's Thyroiditis and thyroid cancer. In fact in many, this disease is detected after the diagnosis of hyperthyroidism, but in some this eye disease could develop even long after or before their thyroid problem becomes apparent.

Severe inflammation and swelling in phase I and resolving the muscles that move the eye, scarring and malfunction in phase II with double vision and retraction are features of this disease. Irritation and feeling of vision blurring are common occurrences in both the phases. This is one condition of the eye where much can be done to help the patient.

The ocular irritation can be brought down by simple lubricants. While sleeping helps to overcome the swelling and ache, cold compresses and keeping the head elevated should help.

Oral steroids may help to contain acute inflammation and vision loss. But these have to be consumed with caution as they may have other side effects including worsening mood disturbances. Oral selenium is often beneficial in mild disease. Some may require radiotherapy for swelling. Those in phase II may require surgery for thyroid eye disease. Double vision can also be fixed by surgery to move the eye muscles. Unfortunately, persons with hyperthyroidism may undergo treatment for their increased thyroid, this does not in any way help the eye disease much and sometimes patients are left with permanent abnormalities. But the good news is that current treatments are long term and double vision and visual loss have become very uncommon.

Thyroid

Thyroid is a gland in the neck overlying the windpipe that regulates the speed of metabolic processes by producing a hormone with the eponymous name thyroxin. Thyroid is an endocrine gland. The thyroid gland which resembles a butterfly, sits astride the trachea. Its secretion - thyroxin, a hormone that regulates the metabolic activity of the body. Too much thyroxin races the metabolism resulting in weight loss, temperature elevation, nervousness and irritability. On the other hand, too little thyroxin slows down the metabolism rate resulting in deep voice, weight gain and water retention. This can result in retardation in physical growth and mental development in children. Both conditions equally affect hair and skin growth, bowel function and menstrual flow.

The thyroid gland is often enlarged whether it is secreting too much hormone, too little or even when it is functioning normally. The thyroid is controlled by the pituitary gland, which secretes Thyroid Stimulating Hormone (TSH) in response to the amount of thyroxin in the blood. TSH increases the amount of thyroxin secreted by the thyroid and also causes the thyroid gland to grow.

Hyperthyroid Goiter : If the amount of TSH is high, the thyroid will both enlarge and secrete too much thyroxin. The result is termed as Hyperthyroidism with a goiter. Graves' disease is the most common form of this disorder.

Euthyroid goiter : If dietary iodine is insufficient, too little thyroxin will be secreted and the pituitary will sense the deficiency and produce more TSH. The thyroid gland will enlarge enough to make sufficient thyroxin.

Hypothyroid goiter: If dietary iodine is severely low, even an enlarged gland will not be able to make enough thyroxin. The gland may keep growing under the influence of TSH, but it may never make enough thyroxin.

An endocrinologist who specializes in the endocrine system can also be consulted for thyroid problems and diseases. Specialists who deal with thyroid problem are called thyroidologists. Thryoidologist and endocrinologist are specially trained doctors who diagnose and treat diseases affecting the thyroid gland. A thyroid specialist continues specialized education focused on thyroid issues after obtaining a Masters degree in medicine. He is qualified and trained to treat conditions that are complex and involve many systems within the body that may be affected due to thyroid imbalance.

A primary care doctor too often misses the diagnosis of a thyroid disease. Sometimes primary care doctors refer patients to a thyroid specialist when there is problem in the endocrine/ hormone systems. Thyroid specialists treat patients with too much or too little thyroid hormone. The thyroid specialist helps the patients to reach a hormone balance by replacing or blocking thyroid hormone. Thyroid specialists also receive special training to manage patients with thyroid growths or thyroid cancer and enlarged thyroid glands. There are times when the services of a thryoidologist or an endocrinologist become absolutely necessary.

• A thyroid specialist has to be consulted when a patient is suffering from the hyperthyroid autoimmune - Graves' disease. This is a condition which can be treated only by a thyroid specialist and not by a regular GP. Graves's disease and hyperthyroid management involves a number of therapies, anti thyroid drug use, radioactive iodine treatments and even surgery if necessary.
  
• Evaluation and treatment for thyroid nodule can be rendered only by thyroid specialists. Thyroid nodule is evaluated by ultrasound and fine needle biopsy process. This is done to rule out the possibility of thyroid cancer.
  
• Thyroid cancer is rare and less than 15000 new cases are diagnosed every year. An expert thyroid specialist is highly recommended to diagnose, evaluate, treat and help in long term follow up and support management of thyroid cancer.
  
• Thyroid surgery is performed when the gland becomes so large that is cosmetically disfiguring. This is normally done if a thyroid has markedly enlarged for years. Thyroid surgery should be performed by an experienced thyroid surgeon. Only an experienced thyroid surgeon can handle the complications that can arise due to thyroid surgery.
  
• A thyroid specialist can assess hypothyroidism levels. This is done by evaluation of TSH level. S/He considers other options such as symptoms, family history and clinical factors to make a thyroid diagnosis.
  
• After a person has been diagnosed for hypothyroidism, a thyroid specialist treats and manages the patient for other signs and symptoms as well. Such symptoms are weight gain, depression, brain fog, hair loss, shortness of breath, intolerance to heat and cold, muscle aches and joint pains, constipation, carpal tunnel, high cholesterol, infertility, Fibromyalgia and chronic fatigue syndrome.
  

TSH blood test

A TSH blood test is indicative of the increased or decreased levels of Thyroid stimulating hormone. A thyroid TSH test detects the imbalances in thyroid gland hormone output. A TSH blood test is normally done for diagnosing hypothyroidism, a condition in which the thyroid gland produces fewer hormones than the body needs. The TSH test measures the body's thyroid hormone output level of the thyroid gland. A TSH test is prescribed for a person of any age, male or female with suspected hypothyroid. The normal range of TSH test for an adult is 0.4 - 5.5 mU/ml. TSH gets increased in case of hypothyroid. The test result gets decreased with hyperthyroid. No single laboratory test is 100% accurate in diagnosing different types of thyroid disease. A combination of two or more thyroid tests is normally employed to detect the abnormality of thyroid function.