Thyroid Eye Disease: Understanding Graves' Ophthalmopathy by Elaine A. Moore;
(Your Health Press: 2003)

The first and only book to date about Thyroid Eye Disease written for patients.

 

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TABLE OF CONTENTS
Book Info
Acknowledgements
Introduction

Chapter 1: What is Graves' Ophthalmopathy?
Chapter 2: Subtypes of GO?
Chapter 3: Signs and Symptoms
Chapter 4: Classifying GO
Chapter 5: Orbital Anatomy & Inflammatory Orbital Disease
Chapter 6: Cellular & Immune System Changes
Chapter 7: The Autoimmune Element
Chapter 8: Risk Factors
Chapter 9: Diagnosis
Chapter 10: Conventional Treatment Options
Chapter 11: Complementary Therapy in GO
Chapter 12: Psychosocial Factors: the Survivors

Resources
Glossary
Bibliography
Index

AUTHOR'S INTRODUCTION FROM THE BOOK
Thyroid Eye Disease: Understanding Graves Ophthalmopathy is intended as an educational resource and guide for patients with Graves' ophthalmopathy (GO), an inflammatory eye disorder that often precedes, accompanies, or follows autoimmune thyroid disease. Although the thyroid and eye conditions usually occur simultaneously, GO may occur as much as ten years before and 20 years after the initial thyroid disorder emerges.

The most common types of thyroid disease occur when the thyroid gland fails to secrete adequate thyroid hormone, causing a condition known as hypothyroidism; alternately, the thyroid gland may secrete excess thyroid hormone, causing a condition known as hyperthyroidism. Graves' disease is an autoimmune hyperthyroid disorder and the most common cause of hyperthyroidism.

GO primarily occurs in patients with Graves' disease (80 percent of all cases); and in a smaller number of individuals with Hashimoto's thyroiditis (HT), an autoimmune hypothyroid disorder. GO may also occur in people who have no signs of thyroid disease (these people are said to have euthyroid Graves' disease). Approximately ten percent of all GO occurs in people with euthyroid Graves' disease, and another ten percent occurs in people with HT.

Thyroid associated eye disorders are known by a number of different names, including Graves' ophthalmopathy (GO); thyroid eye disease (TED); thyroid associated ophthalmopathy (TAO); dysthyroid orbitopathy; thyroid ophthalmopathy; immune exophthalmos; and Graves' eye disease. In this book, the condition of thyroid related eye disease will be referred to simply as GO.

Both autoimmune thyroid disease (AITD) and GO, like most autoimmune disorders, result from a combination of genetic and environmental factors. That is, individuals with a certain combination of genes develop AITD and GO when they're exposed to certain environmental triggers, including stress, infectious agents, iodine, interferon and interleukin medications and sex steroids. Thyroid autoantibodies that contribute to the development of AITD also play a significant role in the development of GO, particularly the congestive form of GO. A complex disease, which is unique in each individual, GO may affect the eyelids, the orbital muscles, the orbital connective tissue and the orbital fat deposits.

My goal in writing Thyroid Eye Disease: Understanding Graves Ophthamopathy is to educate, support and empower patients with GO. Intended as an overall guide, this book describes all facets of GO—including the development, signs, symptoms, diagnostic tests, risk factors, conventional and complementary treatment options, complications, and psychosocial manifestations of GO.

Chapter 1 describes what it means to have Graves' ophthalmopathy thyroid related eye disease and introduces the reader to a list of associated medical words and terms. Chapter 2 explains the two primary subtypes of GO and their differences. Chapter 3 looks at the signs and symptoms associated with GO. Chapter 4 describes how GO is classified and the usefulness of these stages. Chapter 5 describes how the eye's tissues and cells work together to create vision, and it describes the changes seen in inflammatory GO. Chapter 6 describes the immune system and its cells and explains how immune system changes contribute to GO. Chapter 7 describes the autoimmune process that results in the congestive, inflammatory form of GO. Chapter 8 describes the genetic, environmental and lifestyle factors that contribute to GO development. Chapter 9 describes the clinical picture, laboratory and imaging tests used to help diagnosis in GO. Chapter 10 describes conventional treatment options and explains their use in the various disease stages. Chapter 11 describes the use of complementary medicine in GO. And chapter 12 describes the psychosocial effects of living with GO. Also included are patient anecdotes, illustrations, a resource section, glossary and index.

In any disease state, but particularly in diseases with an autoimmune origin, knowledge is empowering. Armed with an understanding of the endocrine, environmental, genetic and immunological factors that lead to GO, you can better understand how this disease develops and realize the importance of your own role in the healing process.

Studies show that the amount of time and energy you invest in your own healing directly affects your outcome. With several therapeutic options available for GO, you must be able to weigh benefits against side effects and have an active voice in your own treatment plans. Recent advances in immunology have demonstrated that the endocrine, immune and nervous systems work in harmony, and anything that influences one system influences the others. Thus, the role of dietary changes, supplements, and the avoidance of environmental triggers must all be taken into consideration. By learning what foods promote inflammation or how chronic stress harms the immune system, you'll soon be able to modulate your body's own immune responses.

While usually mild and manageable, the signs and symptoms of GO are often more debilitating than their related thyroid disorders. Furthermore, thyroid related eye disorders have other ramifications besides the obvious medical concerns. The resulting cosmetic disfigurement can cause psychosocial distress, inability to work and considerable financial hardship during the active disease stages. Even after the disease has stabilized and resolved, one or more corrective surgeries may be required.

While various treatments are available to treat GO, the period in which their use is beneficial and the order in which treatments should be administered are as important as the therapy itself. This book includes a thorough description of treatment options—be they conventional or complementary—with an added emphasis on the role of self-care.

While the intricate workings of the immune system are complex and beyond the scope of this book, several sections, particularly in chapters 6 and 7, describe how the immune system contributes to GO development. Other sections, especially in chapters 8 and 11, show how diet, stress and other environmental factors influence immune system health. Adopting a lifestyle that promotes immune system health is the first step when it comes to healing and remission in GO.

While the disease process in GO is indeed complex and appears mysterious at first glance, the steps that lead to GO are logical and orderly. More importantly, the effects of GO and the severity of its symptoms are partially under your control. Some of the most powerful healing tools, such as avoiding sugar to prevent inflammation or drinking sufficient water to prevent dryness and tearing, are easy. Maintaining appropriate thyroid hormone levels will also affect your disease course. Avoiding cigarette smoke may be more difficult, but the results can be particularly dramatic. Incorporating helpful lifestyle changes and modulating the immune system are achievable goals. Let this book be your guide to both understanding how GO develops and learning how you can influence its course and attain both remission and recovery.

THYROID EYE DISEASE FAQ
Q. How does smoking affect thyroid eye disease?
A. People with Graves' disease (GD), who smoke are 7.7 times more likely to develop thyroid eye disease (TED), also known as Graves ophthalmopathy (GO) than nonsmokers with graves' disease.

Q. How are steroids used to treat thyroid eye disease?
A. A short course of steroids often helps symptoms of GO, although when used at higher doses, symptoms may return in full force when the steroids are discontinued. Natural methods used to slow down the immune system, including dietary changes, can also help reduce symptoms.

Q. How many Graves' patients can expect to develop GO?
A. With sophisticated imaging tests, nearly all GD patients show evidence of ocular changes. However, clinically significant GO only occurs in 10% to 25% of GD patients. Of these, only 5% have severe GO.

Q. How do doctors classify the severity of eye symptoms?
A. Eye symptoms are classified by a system called NOSPECS with class 0 = no symptoms and class 6 = sight loss due to optic nerve compression.