PART - 5

   KNOW  ABOUT  TED     ( salient features only )

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                               TED : ---- Also called ------
Thyroid Eye Disease
Exophthalmos in Graves Disease
Thyroid Associated Orbitopathy ( TAO )
Ophthalmic Graves Disease
Graves Disease Ophthalmopathy ( GDO )
Inflammatory Eye Disease
Graves Eye Disease
Endocrine Orbitopathy

Visible, Prominent, Protruding-out Eye-ball / Eye - balls, sometimes to the extent of POP Eyes, out of the bony Eye-socket, showing more white above & below the black Cornea, spoiling the face and putting the Eyes to high risk from Infections & Injuries, including Vision-loss. Usually seen Bilateral /or becomes Bilateral ( sometimes after many years ), but can be Unilateral. Eye changes are due to TED inflammations affecting Eye-lids and soft tissues inside the bony Eye socket; and, in some cases, outside the Eye - socket i. e. below the Eyes.

Occurs/ seen in Auto-immune Thyroid disorders.    TED is an Auto - immune Inflammatory disease.
Out of Total Number of TED patients: 

     1. 80% are from Hyper-functioning Thyroid (Graves Disease). 

     2. 15% are from Hypo-functioning Thyroid (Hashimoto's Disease). 
     3. 5% are from unclassified group, having Normal-functioning Thyroid. 

In TED, the body's own Defence Immune system goes weak / awry, and this leads to antibody formation-----which causes Inflammations of Orbital contents-------- usually of  Extra-ocular muscles, Orbital fat and of Eye-lid muscles. Hence, the disease mostly lies in between the BALL & BONE. The inside portion of Eye-balls itself is not affected in TED. 

TED cases prefer humidified air;    Hot air and Wind cause problems. 

(Eye signs include------Prominent, Protruding-out Eyes;  Dry Eyes;  Red Eyes; Itchy Eyes; Swollen Eyes
 and Swollen or Pigmented Lids;------- oftenly associated with grittiness and photophobia).
  1. Eye - lid Spasm------

       Slowly turning into persistent Eye - lid retraction. 
       STARE is seen in such cases, which varies with Mood & Alertness. 
  2. Mild TED: 
     (Mild Eye signs)     ( Proptosis 21-23 mm )

       Mild pain or pressure behind the Eyes, and / OR visible swelling below the Eyes. 
       Oftenly STARE is present, which varies with Mood & Alertness. 
  3. Moderate TED: 
     (Moderate Eye signs) 

       Defective visual fields and damage to vision, including Colour vision.
       Double vision present, which can be Horizontal / Vertical / Mixed.
  4. Severe TED: 
      (Severe Eye signs)    ( Proptosis over 28 mm )

       Alarming form of the disease, putting imminent threat to vision. 
       Double vision present, which can be Horizontal / Vertical / Mixed.
  5. Progressive TED: 

       Causing progressive damage to Eyes;   ending in permanent Eye disability. 
       Seen in Graves Disease. 
B. PHASES: (Active;  Reduced - activity;  Inactive) 
  1. Active: ( Wet phase) 

       Inflammatory phase, lasting from some months to as long as 3-years, and having 
       changing Eye signs.
  2. Reduced - activity: 

       Inflammatory process slows down. 
  3.Inactive: (Dry phase) 

       Disease settles down. 
       Slowly and Slowly, this Inactive phase turns into FIBROSIS. 
  1. Vision Loss: 

       Due to pressure on Optic nerve or from Corneal ulcers / Corneal damage. 
  2. Disfigured Appearance: 

       Due to Protruding-out Eye - balls; may end up with POPPY EYES. 
  3. Double Vision; 

      Due to Extra-ocular muscles involvement. Can be Vertical / Horizontal / Mixed.

  4. Has Main 5-D Symptoms: 

      Disfigurement;   Dry Eyes;    Double vision;   Despair;    Dreaded vision-loss.  


     Unpredictable, with somewhat / total recovery only in those LABELLED AS LUCKY ONES. 

  1.   Forced Eye balls Rolling-up Test ---------

           Ask the person to look towards his Scalp Hairs; will be unable to raise affected Eye - ball.

  2.   Antibody Test ------

           Presence of Thyroid auto- Antibodies in blood decides & confirms TED.
   * Found mostly in Females --- starts mostly during first trimester of 
      pregnancy,  OR  in 6-months after delivery. 
      Becoming common in Males also.
      Usually seen in 3rd and 4th decades of life.
  * Not Hereditary. 
  * Iodine Supplements NOT ADVISED. 
  * Stress and Smoking cause it / or enhance it........... NOT ALCOHOL. 
             (usually fright, grief, shock, depressive ailments). 
  * Mood Changes and Alertness aggravate TED
  * NO TEST CAN TELL ---- WHO---- WILL GET IT, ----WHEN----, AND
       OF ----WHAT---- SEVERITY.

   1.   A very notorious disease. In Graves Disease, it can come --------BEFORE--------
         ( say 1-2 years or more), OR -------DURING------, OR AFTER Thyroid disorder
         ( seen even after 15-20 years or more).

   Clinical course of TED and Thyroid  disorder does not go hand in hand. 

TED deteriorates following treatment for Hyper - thyroidism : --------
                   * with medical treatment leading to Hypo - thyroidism.
                   * with Radio-active- Iodine.

   4. TED develops more frequently following Radio-active- Iodine treatment for over - active Thyroid.

   5. Usually, no relationship between TED severity & Thyroid   over-activity.
   6. A small number of cases of TED get VISION LOSS. 

   1. Must Always Maintain Normal Thyroid Status,
        and normal metabolism of your body.

( by any available means )

       Check TSH level: 

       * Keep it supressed in Graves Disease. Patient should not become Hypo-thyroid. 
       * In Hypo-functioning and Normal functioning Thyroid, maintain its normal value. 

   2. In TED and Thyroid Disorders: 

      Take IODINE only from NATURAL SOURCES which are: 

                                                  Banana; Turmeric; Sea foods;

                                                  Green Vegetables; Water Nuts; Pineapple

                                                  Tube and Stem of  Lotus;  Garlic;

                                                   Sesame Seeds


                         FOLLOW THE RULES OF NATURE.


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