Although thyroid eye disease, Graves ophthalmopathy, dysthyroid ophthalmopathy, and Graves disease are all used interchangeably, current preference for the ocular changes that can occur with thyroid disease is to use the term thyroid associated ophthalmopathy (TAO) or orbitopathy. Not only is this more specific, but it covers the fact that TAO can occur despite all testing for thyroid disease being normal. TAO is an autoimmune disorder, and it can involve nearly all the ocular structures. Thus, symptoms are related to which ocular structures are affected. The list of possible presentation symptoms include:
Chemosis of the conjunctiva
Red, angry-looking eyes (especially overlying the insertions of the rectus muscles)
Visual blurring or loss
Visual Field loss
Photopsia on upgaze
Ocular pain and/or pressure
Some 80% of patients with systemic hyperthyroidism develop TAO. TAO affects women 2.5-6 times more frequently than men, just as Graves disease is more prevalent in females. Graves disease is more common in African Americans and Asians compared with whites. Interestingly, when TAO is present in males, it is usually more severe. The usual age range is 30-50 years.
ICD10CM: E05.01 – Thyrotoxicosis with diffuse goiter with thyrotoxic crisis or storm
SNOMEDCT: 276177000 – Thyroid eye disease
Differential Diagnosis & Pitfalls
The differential diagnosis for TAO includes:
– Onset of proptosis is faster; there is other evidence of infection.
Carotid cavernous fistula – Often cranial bruit present.
(orbital pseudotumor) – Ptosis more often than lid retraction, isolated enlargement of lateral rectus muscle.
Parinaud syndrome – Globes elevate on doll's head maneuver; no proptosis or injection.
Again, it is important to remember that just because the testing for thyroid dysfunction is negative, it does not rule out TAO.
Remember also that thickened extraocular muscles can occur with , metastases, , amyloid limited to these muscles and , and .
Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.