Eyes suddenly got bigger? Be alert!

Hyperthyroidism is a relatively familiar disease. Many people associate it with common symptoms such as "eating a lot but not gaining weight, hand tremors, and swollen neck." Many also associate it with protruding eyes. Indeed, 10% to 15% of hyperthyroidism patients experience noticeable proptosis, and its treatment poses challenges for both patients and doctors. Today, let's discuss the issue of proptosis in hyperthyroidism.

Why do eyes protrude?

80% of hyperthyroidism patients is caused by toxic diffuse goiter (also known as Graves' disease), an organ-specific autoimmune disease. Its pathogenesis is not yet fully understood. It is currently believed to be caused by a series of factors that lead to the erroneous activation of the body's immune system and incorrect identification. In hyperthyroidism, due to the action of excessive thyroid hormone, the body's sympathetic nerves become more excited, causing the eyelids to open wider, making the patient's eyes appear larger and giving the impression of protrusion.

What to do about protruding eyes?

Examination

For patients with proptosis, ophthalmologic B ultrasound, CT or MRI imaging examinations should be performed first. On the one hand, this helps rule out the possibility of retrobulbar tumors or space-occupying lesions causing proptosis. On the other hand, MRI also helps assess the degree of edema and inflammation in the extraocular muscles and adipose tissues, which is helpful in guiding drug treatment for proptosis.

Assessment

After ruling out proptosis caused by retrobulbar lesions, according to domestic and international guidelines, two aspects should be assessed for patients with proptosis: the degree of proptosis and the degree of inflammation. It should be noted that sometimes the more severe the inflammation, the more severe the proptosis; however, sometimes the inflammation is not obvious, but the proptosis is significant. Therefore, clinical treatment is not entirely based on the patient's subjective feeling of whether the proptosis is obvious, but mainly based on the above-mentioned imaging examinations and assessments of the degree and activity of proptosis to formulate corresponding treatment measures.

Basic Treatment

Basic treatment for hyperthyroidism includes adjustments to basic lifestyle habits such as rest, smoking cessation, and avoiding eye strain, as well as the use of medications such as methimazole and propylthiouracil to control thyroid function. In some patients with proptosis, the cause is over-excitation of the sympathetic nerves due to hyperthyroidism, resulting in noticeable eyelid opening. In such cases, normal eye appearance can be restored by simply treating the hyperthyroidism.

Specific Treatment

1 Medical treatment. Medical treatment targets inflammation, as inflammation causes edema in the extraocular muscles and adipose tissues, leading to proptosis. The most commonly accepted medical treatment for proptosis is intermittent pulse therapy with corticosteroids, using high doses of corticosteroids for a short period. This effectively controls eye inflammation, buying time for subsequent surgical treatment. Approximately 1/3 of patients can restore their normal eye appearance with corticosteroid pulse therapy alone.

2 Surgical treatment. Surgical treatment for proptosis is sometimes necessary because the proptosis is too obvious and affects eyelid closure, making it necessary to perform temporary tarsorrhaphy to prevent secondary corneal ulceration. In other cases, after the inflammation associated with proptosis is significantly controlled with medical treatment, orbital decompression surgery or other plastic surgery is performed to restore a relatively normal appearance.

What should patients with proptosis pay attention to in their daily lives?

1 To date, there are still several unclear aspects of proptosis. What we can do now is to pay attention to rest, eye hygiene, and smoking cessation; at least these points have been clearly shown to be helpful in the treatment of proptosis.

2 Some patients with proptosis may not have hyperthyroidism because their erroneous immune activation is not directed at the thyroid gland but only at the eye tissues. These patients do not need to be treated for hyperthyroidism, but only for proptosis.

3 During the treatment of proptosis, you should follow the guidance of a professional doctor for orderly treatment. Do not listen to rumors and adopt treatments of unknown effectiveness, as this may lead to prolonged proptosis and may also weaken or even invalidate the currently recognized effective corticosteroid pulse therapy, leading to a therapeutic dilemma.