Graves’ Disease

Ipoh Echo’s EYE HEALTH series continues with Consultant Eye Surgeon Dr S.S. GILL talking to us about Thyroid Eye Disease.

The thyroid gland is an important organ in the front of the neck that releases thyroid hormones which are “chemical messengers” essential for managing the body’s metabolism. When the gland functions well, it goes unnoticed but when it becomes hyperactive it may result in eye problems known as Thyroid Eye Disease or Thyroid Orbitopathy, Ophthalmic Graves’ Disease or Thyroid Ophthalmopathy.


Thankfully this is not a very common condition. In every 100,000 people, approximately 15 women and three men are affected by Thyroid Eye Disease, mainly in the middle age group. There is a genetic link, making those in some families to be more predisposed to suffering from Thyroid Eye Disease. It is the most common cause of protruding eyes (proptosis).


Muscles and fat surrounding the eyeball gets inflamed (swollen) causing the following eye symptoms:

  1. Eyes protrude or bulge out of its sockets – an appearance that the person is staring!
  2. More of cornea (transparent part of the eye) and the conjunctiva (white of eye) get exposed because the eyelids may not be able to close fully (eyelid retraction).
  3. Intermittent sharp pain when the cornea dries out especially when the person is concentrating on something for long, as in reading.
  4. Some people get diplopia (double vision) because the eye muscles are unable to move properly due to the swelling of the eye muscles.
  5. Blurring vision in some patients.

This may happen along with other features such as irritability or nervousness (mood disturbances), preference for cold environments, increased sweating, insomnia (sleeping difficulty), palpitations (a rapid heartbeat), tremor of the hands, weight loss, frequent bowel movements, unexplained fatigue or weakness of muscle, difficulty in conception and irregular menstruation.


If a doctor suspects Thyroid Eye Disease, the following tests are usually done:

  1. Thyroid Function Test (blood test): This will measure hormone levels in your body which includes TSH (Thyroid Stimulating Hormone), T4 (main thyroid hormone) and another thyroid hormone T3, plus Thyroid Stimulating Immunoglobulin Test (TSI). The other blood test that may be done is the RAIU test (Radioactive Iodine Uptake) – which helps to evaluate the Thyroid gland and to find out the cause of increased production of thyroid hormones (hyperthyroidism).
  2. Thyroid Scan – to determine the shape and size of the thyroid gland and to pick up any thyroid nodules that may be benign or cancerous.
  3. MRI Scan of the Orbits – to determine the amount of proptosis (bulging forward of eyes) and the amount of inflammation of the eye muscles within the eyeball sockets.

More on Thyroid Eye Disease prognosis and treatment in the next issue.

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