Graves disease

Graves’ disease is an autoimmune disorder that results in the overproduction of thyroid hormones (hyperthyroidism). Your immune system attacks the thyroid and causes an over production of thyroid hormone (more than your body needs). The thyroid is a small gland situated at the front of the neck. The function of your thyroid is to release hormones into the body. These regulate metabolism, body temperature, muscle strength, and many other functions in the body. Graves’ disease is a common cause of an overactive thyroid although there are several disorders that have the same effect. Because thyroid hormones affect so many body systems, signs and symptoms of Graves’ disease can be wide ranging.

If left untreated, hyperthyroidism can cause serious problems with the heart, bones, muscles, menstrual cycle, and fertility. Graves’ disease also can affect your eyes and skin. This leads to thyroid eye disease.

Thyroid eye disease is inflammation around the eye and is associated with Graves thyroid disease. The typical early warning symptoms of red eyes, recurrent or persistent eyelid swelling or puffiness around the eyes, or chronic watery eye (epiphora) should not be ignored. Whilst changes are often slow, they can occur suddenly. When severe, the disease causes disfigurement, double vision and blindness.

Thyroid eye disease is more common in females than males and its exact trigger remains unknown. Thyroid eye disease can be associated with diabetes or myasthenia gravis and is worse in cigarette smokers. The typical patient is female in her 40’s complaining of puffy eyelids, which they often interpret as a cosmetic problem rather than disease. They usually discuss their symptoms with friends but are less inclined to mention these to their GP, feeling that such concerns would be interpreted as ‘vanity’. Suspicion is higher if the patient develops asymmetry.

The early features of Thyroid eye disease are:

  • puffiness of the upper and/or lower eyelids
  • redness or swelling of the conjunctiva (chemosis)
  • watery eyes, typically associated with puffiness
  • wide eyed stare
  • unequal eyelids

As the disease progresses, more established features occur like exophthalmos (bulge of the eyeball), double vision, and asymmetry of upper and lower eyelid. Loss of vision may occur at any time, but more typically with advanced disease.