What is Thyroid Eye Disease?
Thyroid Eye disease is an ocular condition that usually occurs as a result of Graves' disease. This autoimmune disease involves antibody action against receptors within thyroid cells and also within cells behind the eyes. People with Graves' disease usually experience hyperthyroidism. Approximately half of them develop symptoms affecting the eyes. Because thyroid eye disease can worsen to a point at which it becomes difficult to close the eyes completely, it is important that patients with the signs of this condition receive appropriate care.
What Are The Symptoms of Thyroid Eye Disease?
The symptoms of thyroid eye disease include the following:
- Persistent inflammation and redness of the white part of the eyes
- Persistent sensation of grittiness and general eye irritation
- Dry eyes
- Excessive tearing
- Eyelid swelling
- Proptosis, bulging of the eyes
- Double vision
The severity of the symptoms of thyroid eye disease is completely independent of the severity of hyperthyroidism.
How Can Thyroid Eye Disease be Treated?
There are several approaches that may be taken to diminish the symptoms of thyroid eye disease. Historically, these have included:
- The use of cool compresses to reduce inflammation around the eyes
- Wearing sunglasses to reduce photosensitivity when outside
- The use of lubricating eye drops to soothe irritation caused by dry eye
- Steroid medication to reduce swelling behind the eyes
For more advanced cases of thyroid eye disease, a patient may be advised to have eyelid surgery to reposition tissue and acheive better eyelid closure. Surgery may be recommended to lengthen the muscles around the eyes to correct double vision. Finally, some patients need orbital decompression surgery to create more space within the eye socket.
In addition to lifestyle remedies and surgery, we now have a mid-range treatment for thyroid eye disease, Tepezza.
What is Tepezza?
Tepezza (teprotumumab) is the first medication of its kind. The FDA has approved the drug, administered via IV infusion, to reduce the symptoms of thyroid eye disease. Patients who have received Tepezza report a reduction in redness, double vision, bulging, swelling, and irritation.
How Does Tepezza Work?
Thyroid eye disease can cause the eyes to bulge through action within the tissue behind the eye socket. Here, the tissue has receptors that receive nerve signals. Thyroid eye disease "turns on" these receptors by creating autoantibodies that attack the tissue. In response to the activated receptors, the fat and muscle tissue behind the eyes swells. The ocular surface also becomes inflamed as a result of the activation. Tepezza works by binding to the receptors that would otherwise get activated. By preventing the receptors from turning on, Tepezza helps reduce the swelling and inflammation that occurs around the eyes. This medication has been proven to improve aesthetics as well as visual stability.
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Am I a Good Candidate for Tepezza?
Thyroid eye disease is a complex condition that requires careful and comprehensive evaluation. Our objective is to provide the most appropriate care for each patient, and we are familiar with the multiple criteria that are used to determine who may respond optimally to this treatment. The criteria that are used classify the stage, subtype, and variations that may be involved in each case. With evaluation of each, we can determine who is a good candidate for Tepezza. As much as we wish there were a straightforward answer to this question, the nuances of thyroid eye disease make it difficult to do so outside of a personal consultation.
How Long Will it take for My Thyroid Eye Disease Symptoms to Improve?
Data received through clinical trials suggests that patients can experience improvements in the symptoms of thyroid eye disease within six weeks of starting Tepezza treatment.
How Long Do I Have to Take Tepezza?
Tepezza is an innovative treatment that can help many people diagnosed with thyroid eye disease. It is a medication but it's not one that you take on a daily basis. Tepezza is administered as an IV infusion. It's administered in the office by the doctor, nurse practitioner, or registered nurse. To get the best results from Tepezza treatment, it is imperative that you complete the entire course of treatment, unless the doctor determines that it is not in your best interest (usually due to side effects). This takes place over the course of about five months. During your treatment program, you'll receive an IV infusion once every three weeks for a total of eight treatments. The first two infusions take about 90 minutes; the remaining sessions take about one hour. Your medication dosage will be determined by your weight at the time of each infusion.
Can Thyroid Eye Disease Come Back after Tepezza Treatment?
Thyroid eye disease cannot be cured, even with Tepezza. The purpose of this course of treatment is to minimize your symptoms and reduce the risks associated with excessive pressure in the eye socket. Tepezza is still a relatively new modality for managing thyroid eye disease. However, according to current data, it seems that the vast majority of patients achieve good results with just one round of infusions. One study has suggested that approximately 15 percent of patients treated with Tepezza experience a recurrence of their symptoms, referred to as a flare-up. In such situations, another round of infusions may be warranted. If you achieved good results from your first Tepezza treatment, we anticipate you will achieve similar improvements with a second series of sessions.
What is Orbital Decompression?
As much as possible, we take a conservative, non-surgical approach to the treatment of thyroid eye disease. Working with your primary doctor to manage your overall thyroid condition is imperative. You may also engage in the lifestyle habits that are recommended for you. If your thyroid eye disease becomes severe and presents a risk to your vision, your doctor may recommend orbital decompression surgery. The purpose of this procedure is to create more space within the orbital socket.
Why is Orbital Decompression Done?
A doctor may advise you to consider orbital decompression to address more significant symptoms of thyroid eye disease. These may include chronic eye pain caused by compression on the optic nerve, severe eye bulging (exophthalmos), Scar tissue on the cornea, vision impairment, cosmetic concerns, or chronic eye irritation due to excessive dryness.
Patients who undergo orbital decompression surgery can gain comfort, greater confidence in their appearance, a reduction in chronic symptoms like headaches and blurry vision or eye irritation, and overall improved orbital function. The recovery period after this procedure is just one to two weeks, during which time it's necessary to take it easy and avoid bending over. While swelling and bruising are expected during the early recovery period, patients typically see the positive effects of orbital decompression right away.
What Are the Possible Side Effects of Tepezza?
According to data, only about 4% of the patients who have been treated with Tepezza have developed side effects. Most side effects occur either during treatment or shortly thereafter. These may include nausea, diarrhea, muscle cramps, muscle spasms, headache, fatigue, change in taste, hearing impairment, elevated blood sugar, dry skin, and hair loss. If side effects occur, they may resolve as the body adjusts to the medication.
Schedule a Consultation
In clinical studies, two out of three people saw improvements with the use of Tepezza. This treatment for thyroid eye disease may not be right for everyone, but it may be right for you. To learn more, contact our Amarillo office at (806) 351-1177 or (800) 782-6393.