Eye exercises for endocrine ophthalmopathy. Endocrine ophthalmopathy: a threat to vision. Causes, including after removal of the thyroid gland

Severe damage to the organs of vision - EOP or endocrine ophthalmopathy - is a consequence of autoimmune diseases of the thyroid gland. The clinical picture is a complex of negative signs that negatively affect vision, the condition of the eyelids and eye muscles.

Why does the image intensifier develop? How to recognize the first signs of endocrine ophthalmopathy? How to distinguish a disease of autoimmune origin from infectious lesions of the organs of vision? Can EOP be cured? The answers are in the article.

Endocrine ophthalmopathy: what is it?

The inflammatory process and swelling in the tissues of the retrobulbar area is accompanied by a complex of ophthalmological symptoms. A characteristic sign is bulging of the eyes, impaired traction of the upper eyelid, negative changes in the cornea against the background of exophthalmos. Pathology affecting the organs of vision develops against the background of autoimmune lesions of the thyroid gland.

Endocrine ophthalmopathy is one of the complications of Graves' disease. Bug eyes are a specific sign of image intensifier. If the eyeballs bulge, the patient should consult an endocrinologist, then visit an ophthalmologist.

Exophthalmos is the first sign of hormonal disorders. With toxic goiter, a quarter of patients develop damage to the organs of vision. In most cases, 12-18 months pass between the development of thyroid pathologies and the appearance of ophthalmopathy. In the majority of patients, disorders in the area of ​​the extraocular muscles and retrobulbar tissue appear in both eyes. If diagnosed untimely or improperly treated, severe damage to the optic nerve may occur, which can lead to blindness.

In most cases, EOP develops in women: hormonal disorders in this category of patients occur more often. Men are less likely to experience endocrine ophthalmopathy, but the symptoms and complications are more severe.

Depending on the severity of the clinical picture, several classes of endocrine ophthalmopathy are distinguished:

• null- there are no negative signs;
• first- retraction in the upper eyelid area, a change in the nature of the gaze due to a later drooping of the eyelid when closing the eyes;
• second- swelling of the eyelids and conjunctiva, sclera appears;
• third- exophthalmos or bulging eyes develop;
• fourth- the eye muscles are involved in the pathological process: vision is blurry, objects appear double;
• fifth- lagophalmos develops (with a protruded eyeball it is impossible to completely close the eyelids), ulceration zones form on the cornea due to dryness and constant exposure to atmospheric factors (wind, sun), and keratopathy appears;
• sixth- the optic nerve is damaged, visual acuity quickly decreases.

Diagnostics

Signs of ophthalmopathy are a reason to visit an endocrinologist. It is important to differentiate image intensifiers from eye pathologies of a non-endocrine nature.

For diagnosis the following is carried out:

• CT scan of the orbit.
• Ultrasound of the eyes.

Additionally, it is prescribed if the patient has not previously contacted a specialized specialist regarding hormonal disorders in the thyroid gland.

Effective Treatment Options

The nature of therapy depends on the class of image intensifier. First, a complex of drugs is taken, and if the method is poorly effective and complications develop, eye surgery is prescribed.

Important! Folk remedies are not used in the treatment of endocrine ophthalmopathy. The disease is of an autoimmune nature; herbal decoctions do not have a powerful effect on pathological processes. You can take a course of herbal remedies to normalize the functioning of the thyroid gland and restore metabolic processes, but only as an additional measure of therapy and to prevent endocrine disorders.

Conservative treatment

Therapy goals:

• reduce the risk of developing keratopathy;
• moisturize the conjunctiva;
• stop the process of destruction in the orbital tissues;
• normalize retrobulbar and intraocular pressure;
• restore vision.

An important point is the stabilization of hormonal levels and the achievement of a euthyroid state. Without normalizing thyroid function, it is impossible to stop the progression of endocrine ophthalmopathy and prevent orbital fibrosis and vision loss.

Effective names are used to treat eye damage:

• Cyclosporine.
• Prednisolone.
• Levothyroxine.
• Sandostatin.
• Methylprednisolone.
• Pentoxifylline.

For the treatment of EOP, a complex of drugs is prescribed:

• thyreostatics;
• thyroid hormones;
• cytokine blockers;
• somatostatin analogues;
• monoclonal antibodies.

If indicated, hemosorption or plasmapheresis is performed to actively remove toxins from the body. Often, the doctor prescribes x-ray therapy (16 or 20 Gy is enough for a course).

Antibiotics, glucocorticosteroids, and synthetic hormones are used orally and for eye treatment strictly as prescribed by a doctor. It is prohibited to violate the dosage regimen and instructions for use. Incorrect treatment worsens the prognosis of endocrine ophthalmopathy and provokes vision loss.

With mild to moderate degrees of EOP, the patient undergoes outpatient treatment. Referral to a hospital is required for severe damage to the organs of vision due to complications, progressive lagophthalmos and exophthalmos, corneal ulcers, a significant decrease in mobility in the eyeball area and severe drying of the conjunctiva. Hospitalization is required if the development of optic neuropathy is suspected.

How to determine at home and how to treat the disease? We have the answer!

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Surgical intervention

In case of low effectiveness of drug therapy, or a significant complication of the course of endocrine ophthalmopathy, the doctor prescribes surgery to restore the optimal size of the eyelids and normalize the function of the extraocular muscles. The patient should be observed in a high-level eye center to exclude untimely appointment of surgical intervention and adverse reactions after a complex operation.

Indications:

• prolapse and swelling of the lacrimal gland, ptosis, lagophthalmos, retraction - disorders in the eyelid area;
• development of endocrine myopathy with minor retraction of the upper eyelid, decreased functionality of the extraocular muscles;
• expansion in the area of ​​retrobulbar tissue, provoking serious disorders, a pronounced cosmetic defect against the background of subluxation of the eyeball;
• diplopia. The result of surgery is restoration of the correct length of important eye muscles.

Recovery prognosis

With timely contact with an ophthalmologist, image intensifier can be completely cured. It is important to carry out competent complex therapy, always under the guidance of an endocrinologist. Patients often visit an ophthalmologist, who sometimes makes the wrong diagnosis: the result of a foreign body, blepharitis, conjunctivitis. The best option is to undergo treatment in a special endocrinology center.

Orbital fibrosis is a severe, often irreversible change in the condition of the visual organs. The patient feels pain in the eyeballs, exophthalmos and diplopia develop, and the inflammatory process is activated. Against the background of fibrosis of the orbit, vision deteriorates significantly.

If signs of endocrine ophthalmopathy appear, you should not self-medicate. Therapy under the guidance of an endocrinologist and ophthalmologist in a specialized medical center is the best option for eliminating pathological manifestations and preventing complications. It is important to know that without normalizing the secretion of thyroid hormones, it is impossible to completely cure EOP. Lack of therapy or self-medication can lead to blindness and severe damage to all structures of the visual organs.

From the following video you can learn more useful information about the symptoms and methods of treating endocrine ophthalmopathy:

Content

Protruding eyes are the main symptom of endocrine ophthalmopathy. This disease is also known as Graves' ophthalmopathy, named after the scientist who first described the signs of the pathology. With this condition, the posterior (retrobulbar) tissues of the organ of vision and the muscles of the eyeball are affected, which leads to its displacement. The pathology manifests itself as bulging eyes, tearing, swelling of the eyelids and conjunctiva. At an advanced stage, the optic nerve atrophies and vision deteriorates significantly.

How does Graves' ophthalmopathy manifest?

In 95% of cases, the cause of damage to the soft tissues of the orbit is diffuse toxic goiter, which develops due to thyrotoxicosis, in which the thyroid gland produces an excessive amount of iodine-containing hormones. Ophthalmopathy can manifest itself both during the disease and before its onset, and ten years later. The mechanisms by which retrobulbar tissues are affected are unclear. It is believed that the triggering factors are bacterial or rotavirus infections, intoxication of the body, radiation, stress, smoking, and insolation.

The pathology is autoimmune in nature. This is the name for a condition in which the immune system begins to attack and destroy healthy tissue, mistaking them for pathogenic cells. According to one version, the immune system perceives the fiber that surrounds the eyeball as a carrier of receptors for iodine-containing thyroid hormones. This is regarded as an abnormal condition, and in order to eliminate the problem, the immune system produces antibodies to destroy them.

Having penetrated the tissues of the orbit, antibodies cause inflammation with infiltration (accumulation of foreign particles). In response, fiber synthesizes glycosaminoglycans - substances that attract liquid. The result is swelling of the eye tissue and an increase in the extraocular muscles, which are responsible for pressure in the bony base of the eye socket.

This leads to exophthalmos - displacement of the eyeball forward and the appearance of bulging eyes. Sometimes it goes to the side, a symptom of which is strabismus. Over time, the inflammation subsides, the infiltrate is converted into connective tissue. In its place, a scar is formed, after which the displacement becomes irreversible.

To avoid this, it is important to notice the symptoms of pathology in time, contact an endocrinologist and begin treatment for the underlying disease. At the initial stage, endocrine ophthalmopathy cannot be treated as an independent disease. In severe cases, surgery may be prescribed. This could be surgery on the eyelids, oculomotor muscles, orbital decompression for exophthalmos.

Early signs

Ophthalmopathy with thyrotoxicosis has a favorable prognosis in treatment: in 10% of cases there is an improvement, in 60% - stabilization of the condition. For this reason, it is very important to notice early signs of the disease in time. At the initial stage, the pathology is manifested by the following symptoms:

• “sand”, a feeling of pressure in the organ of vision;
• watery or dry eyes;
• photophobia;
• swelling around the organ of vision;
• slight bulging eyes.

Stage of advanced clinical manifestations

As endocrine ophthalmopathy develops, the situation worsens. A symptom of this condition is a noticeable enlargement of the eyeballs, redness of the whites, swelling of the eyelids, and double objects. Due to the fact that the eyes are unable to close completely, ulcers form on the cornea, conjunctivitis and iridocyclitis develop - inflammation of the iris and ciliary body. Dry eye syndrome often develops.

At the severe stage of endocrine ophthalmopathy, the optic nerve atrophies, eye mobility is limited, which causes intraocular pressure to increase and pseudoglaucoma develops. Retinal vein occlusion (blockage) may occur, leading to vision loss. If the pathological process affects the muscles of the organ of vision, strabismus often develops.

Classification

There are several types of classification of endocrine ophthalmopathy. Depending on the manifestations of symptoms, three stages of pathology are distinguished:

• The first degree is characterized by slight bulging eyes, when the eyeball protrudes forward no more than 16 mm. Symptoms of this stage are moderate swelling of the eyelids, without disruption of the oculomotor muscles and conjunctiva.
• The second degree of endocrine ophthalmopathy is characterized by protrusion of the eyeball by 18 mm. At this stage, there is severe swelling of the eyelids and conjunctiva, and periodic double vision.
• A symptom of the third degree is pronounced bulging eyes: the forward deviation is up to 21 mm. The patient cannot completely close his eyes, erosions and ulcers appear on the cornea, the eyeball loses mobility, and the optic nerve atrophies.

Features of symptoms depending on the type of disease

In medical practice, there are three forms of pathology - thyrotoxic exophthalmos, edematous form, endocrine myopathy. The symptoms of these varieties have some differences, as can be seen from the following table:

Type of endocrine ophtolopathy		Symptoms
Thyrotoxic exophthalmos		slight protrusion (protrusion) of the eyeballs; retraction of the upper eyelid, when it is located too high, exposing the white; slight tremor of closed eyelids; the muscles around the eyes move without problems; no changes are detected at the bottom of the eye
Edema exophthalmos
	1st stage of compensation	In the morning there is slight drooping of the upper eyelid, which disappears throughout the day. The eyes are completely closed at this stage. Over time, partial drooping of the eyelid transforms into persistent retraction due to spasm and prolonged tone of the eye muscles. This leads to contracture (limited mobility) of the Müller muscle, which is responsible for accommodation (adaptation) and the superior rectus muscle of the eye
	Stage 2: subcompensatory	the area along the lower eyelid, the outer corner of the palpebral fissure, and the tissue near the organ of vision swell; pressure increases, which increases with eye movement; bulging eyes quickly increase, and soon the eyelids stop closing completely; the vessels of the sclera expand, the vessels of the sclera begin to wriggle, eventually forming a figure resembling a cross
	Stage 3: decompensatory	a sharp increase in the severity of symptoms; bulging eyes increase; the eye does not close at all due to swelling of the eyelids and periocular tissue; Optic neuropathy develops, during which the optic nerve atrophies; ulcers and erosion appear on the cornea; the final stage – irreversible changes due to fibrosis of corneal tissue; visual impairment due to cataract, optic nerve atrophy
Endocrine myopathy
		In most cases, this type of endocrine ophthalmopathy is observed in men against the background of increased production of iodine-containing hormones by the thyroid gland. The pathology is accompanied by the following symptoms: double vision with a tendency to increase; bulging eyes; there is no swelling, but thickening of the oculomotor muscles occurs, which limits the mobility of the eyeball; tissue fibrosis is observed several months after the onset of endocrine disease

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Endocrine ophthalmopathy or EOP is an ophthalmological disease associated with damage to the eye muscles and tissues. Pathology develops due to autoimmune diseases of the thyroid gland and much less often as a result of thyroiditis or as a separate disease.

Women aged 40-45 and 60-65 years are more susceptible to endocrine ophthalmopathy. But sometimes the disease is diagnosed in children under 15 years of age. In men, the disease is 5-8 times less common. At a young age, endocrine ophthalmopathy is tolerated by patients quite easily, in contrast to older people suffering from severe forms of the disease.

The cause of the development of pathology is autoimmune reactions, in which the immune system begins to perceive the retina as a foreign body, produces specific antibodies that gradually destroy the eye structures, causing inflammation.

After the inflammatory processes subside, healthy tissue begins to be replaced by connective tissue. After a couple of years, scars form and (bulging eyes) persist for life.

Endocrine ophthalmopathy is most often diagnosed in people who have the following pathologies in their medical history:

• hypothyroidism;
• thyrotoxicosis;
• thyroid cancer;
• diabetes;
• Hashimoto's thyroiditis.

In 15% of people, thyroid dysfunction is not detected. In this case, the disease is caused by a bacterial or viral infection, smoking, stress, or radioactive exposure.

Symptoms

Endocrine ophthalmopathy is a severe pathology of an autoimmune nature. It is important to recognize its symptoms in time and consult with an endocrinologist and ophthalmologist for timely treatment. There are early and late manifestations of endocrine ophthalmopathy.

Initially, the disease manifests itself with the following symptoms:

• photophobia (photophobia);
• feeling of sand in the eyes;
• uncontrollable lacrimation.

When the stage of advanced manifestations occurs, diplopia (double image), significant swelling of the eyelids, non-closure of the eyelids, development, headaches, hyperpigmentation of the skin on the eyelids, trembling of the eyelids, their bending, and redness of the eyes are added to the symptoms.

For endocrine ophthalmopathy, a striking sign is exophthalmos, which is manifested by severe protrusion of the eyeballs. The eyelids cannot close completely, as a result of which dry eyes and corneal ulceration develop, which becomes chronic.

The disease leads to damage to the muscles of the fundus of the eye, which causes increased intraocular pressure, thrombosis of the retinal veins, and strabismus.

Classification and degrees

The disease is classified depending on the manifestation of signs and symptoms. In Russia they use the classification according to V.G. Baranov. Its features are discussed in the table

Classification according to Brovkina

According to this technique, endocrine ophthalmopathy has 3 stages, each of which is characterized by its own symptoms.

Thyrotoxic exophthalmos is accompanied by a slight trembling of the eyelids when they are closed, and a lag of the eyelids when lowering the eyes. If the pathology progresses rapidly, myopia develops and double images of objects appear. These symptoms are characteristic mainly of men suffering from hypothyroidism of the thyroid gland. Bulging eyes gradually develop, but no swelling of the tissue is observed, but the volume of the eye muscles increases.

Edematous ophthalmopathy is characterized by bilateral damage to the organs of vision. Symptoms are first observed in one eye, and then within a few months the disease affects the second eye.

This form goes through 3 stages:

1. Compensation. It begins with drooping of the eyelid in the morning. Towards evening the condition improves. As the disease progresses, an increase in the tone of the eye muscles is observed, and the palpebral fissure widens.
2. Subcompensation. This period of the disease is accompanied by an increase in eye pressure, exophthalmos, swelling of the eye tissues not associated with inflammation, and chemosis appears on the lower eyelid. Symptoms of bulging eyes increase very quickly, the eyelids cannot close completely, the small vessels of the sclera branch out and a cross-shaped pattern appears.
3. Decompensation. The eye becomes so swollen that it practically does not move. If treatment is not started, atrophy of nerve fibers will begin and form.

Endocrine myopathy is characterized by weakening of the extraocular muscles and strabismus.

Diagnostics

In order to make a correct diagnosis, you will need to visit an endocrinologist or ophthalmologist. The endocrinologist will prescribe an ultrasound of the thyroid gland to identify its enlargement and nodes. If large nodes are detected, a puncture biopsy is performed, followed by studying the taken gland material for histology. Also, to assess the proper functioning of the thyroid gland, the patient is tested for hormones and the presence of antibodies to gland tissues.

Ophthalmological diagnostics include:

• visometry (determining the clarity of vision);
• assessing the ability of the eyeballs to move;
• perimetry (detection of the boundaries of the visual field);
• fundus examination;
• measuring pressure inside the eye;
• biomicroscopy to assess the condition of the remaining ocular structures.

Differential diagnosis

Differential diagnosis is necessary in order to identify neoplasms, myasthenia gravis, pseudoexophthalmos with a high degree of myopia, which have similar symptoms. For differential diagnosis, the following are prescribed: ultrasound, CT, MRI, blood testing using an immunogram.

After differential diagnosis and confirmation of the diagnosis, disease activity is determined using the CAS scale. Find out from the patient whether he has the following symptoms:

• swelling of the eyelids;
• redness and swelling of the conjunctiva (chemosis);
• pain when trying to shift your gaze;
• swelling of the lacrimal caruncle (caruncles);
• redness of the eyelids.

For each confirmed symptom, 1 point is awarded. If no symptoms are observed, then the disease is in an inactive phase. If 7 signs are present, endocrine ophthalmopathy is considered severe. The disease is considered active if the number of symptoms is more than 4.

Treatment of endocrine ophthalmopathy

The treatment tactics will be chosen by the doctor depending on the degree of activity of the disease and its form.

The goals of therapy are:

• moisturizing the conjunctiva;
• normalization of eye pressure;
• stabilization or elimination of destructive processes inside the eye.

Correction of the thyroid gland is carried out by an endocrinologist. For hypothyroidism, thyroxine is prescribed, for hyperthyroidism, thyreostatics are prescribed. If treatment with medications does not bring the desired result, doctors suggest surgery to remove the entire “thyroid gland” or part of it.

A mandatory component of the treatment process is the use of steroids (Methylprednisolone, Kenalog). With the help of glucocorticoids, they eliminate swelling, inflammation, and suppress the immune system. Cyclosporine (an immunosuppressant) is often prescribed for endocrine ophthalmopathy. It is prescribed both as a separate medicine and as part of a complex treatment together with steroids.

Pulse therapy

This treatment method is prescribed if there is a threat of vision loss. For 3 days, the patient is given intravenous Prednisolone or Methylprednisolone. On the 4th day, the patient is transferred to tablet medications with a reduced dosage. If after 3 days pulse therapy with methylprednisolone does not bring results, surgery is prescribed.

Pulse therapy has a number of contraindications:

• acute infectious and viral diseases;
• hypertension;
• glaucoma;
• severe liver and kidney diseases.

Radioactive iodine

If the thyroid gland is slightly enlarged and nodules are detected on it, the patient is prescribed radioiodine therapy. During the procedure, an active iodine molecule is introduced into the body. It accumulates in the tissues of the thyroid gland, destroying it. As a result, the production of thyroid hormones decreases.

Other therapies

In especially severe cases, the patient is prescribed irradiation of the eye orbits using X-rays. Cryopheresis, plasmapheresis, and hemosorption are prescribed against inflammatory processes.

To improve metabolism and transmission of nerve impulses, the patient is prescribed Aevit, Actovegin, Proserin.

To get rid of dry eyes, moisturizing gels and drops, and artificial tear preparations are used. These are Oftagel, Carbomer, Korneregel.

Operation

Surgical intervention is performed when the lobes of the “thyroid gland” are greatly enlarged, it begins to compress the trachea, esophagus, or when conservative treatment does not bring results.

Decompression of the orbits of the eye is carried out, due to which the volume of the orbits increases and the death of the eye is prevented. During surgery, the orbital walls and affected tissue are partially removed. This slows down the progression of the pathology and reduces bulging eyes.

Correction of the extraocular muscles is carried out for strabismus and severe diplopia. To eliminate a cosmetic defect, the eyelids are lengthened surgically and Botuloxin or Triamcinolone is injected subconjunctivally to achieve complete closure of the eyelids.

In some cases, to achieve complete drooping of the eyelids, lateral tarsorrhaphy is performed, in which the edges of the eyelids are sutured.

Complications after surgery may include bleeding, asymmetry of the eyeballs, eyelids, sinusitis, diplopia, and impaired sensitivity of the eyelids.

Features of treatment for pregnant women

When detecting endocrine ophthalmopathy during pregnancy, expectant mothers should know that this is a disease that is not dangerous to their health and the life of the baby. There is no specific approach to its treatment. During pregnancy, special attention is paid to the functioning of the thyroid gland, especially in patients with thyrotoxicosis and diffuse toxic goiter. To establish an accurate diagnosis and carry out the correct treatment, differential diagnosis is necessary.

Treatment of diffuse goiter during pregnancy is to take 250 mcg of iodine daily, sometimes in combination with levothyroxine sodium.

Treatment of thyrotoxicosis while pregnant is reduced to taking small doses of propylthiouracil. Its goal is to maintain the T4 hormone at the upper limit of normal levels.

The operation is prescribed only in the most difficult cases.

Prognosis and complications

Timely differential diagnosis and proper therapy can achieve stable remission and prevent negative consequences. Approximately 40% of patients experience a significant improvement in their condition, and in the remaining 60% the pathological process stops. After treatment, the person is registered with an endocrinologist and ophthalmologist, with whom he must be examined every six months.

If you do not carry out differential diagnosis, you can confuse diseases that have similar symptoms. In such a situation, the wrong treatment will be prescribed, which will lead to the following complications:

• strabismus;
• blurred vision;
• ulcerative lesions of the cornea.

Prevention

There is no special prevention of endocrine ophthalmopathy. But to prevent the disease, when the symptoms described above appear, you need to promptly contact an endocrinologist or ophthalmologist. You should strengthen your immune system, protect your eyes from harmful influences, and stop smoking.

Doctors must give all patients the following clinical recommendations, regardless of the form of ophthalmopathy:

1. Wear sunglasses
2. Use external remedies to eliminate symptoms (artificial tears, moisturizing drops).
3. Quit smoking and avoid visiting places where they smoke.

Endocrine ophthalmopathy is a complex pathology that affects approximately 2% of the total population of the planet. In most cases, it does not lead to vision loss, but it greatly reduces it. Only timely therapy helps to slow down the development of the disease or completely eliminate it.

Approximately 2% of the population suffers from soft tissue damage to the eyes, which is associated with autoimmune inflammation of the thyroid gland. Symptoms can develop simultaneously with a violation of hormone synthesis, precede dysfunction, or occur after 3-7 years of stable remission, as well as after incomplete removal of the thyroid gland.

In 90% of patients with this pathology, thyrotoxicosis is detected, but low, normal hormone production also occurs. Provoking factors: viral infections; irradiation, including ultraviolet radiation when sunbathing on the beach or in a solarium; smoking; contact with toxic substances at work; autoimmune lesions of joints, soft tissues,; genetic predisposition.

After such exposure, the cells of the immune system mutate and begin to destroy their own tissue of the eye muscles. The compounds formed in response stimulate the synthesis of substances that retain water in the tissues. This leads to swelling of the tissue behind the eyeball. At this stage the changes are still reversible. Over time, the edematous tissue begins to grow into connective tissue fibers with irreversible protrusion of the eyes, complications such as visual impairment, corneal ulcers, and false glaucoma.

Signs and symptoms of pathology at an early stage: tearfulness; feeling of sand in the eyes; increased dryness; pain when looking at a bright light source; swelling under the eyes.

The advanced stage is characterized unilateral or asymmetrical anterior displacement of the eyeball (exophthalmos). Symptoms: swollen eyelids, swelling does not decrease depending on the time of day and drinking regime; noticeable protrusion of the eyeballs; headache; redness of the eyes; doubling of objects; it is impossible to close the eyelids completely.

Lead to inflammation of the conjunctiva of the eyes, iris, corneal ulcers, xerophthalmia (dry eyes). Swelling of the tissue compresses the optic nerve, leading to decreased vision, the development of false glaucoma, blockage of the retinal veins, and strabismus.

thyrotoxic, edematous, myopathic.

Diagnosis of pathology: examination by an ophthalmologist and endocrinologist, blood test, ultrasound of the gland, biopsy, study of visual acuity, fields, function of the eye muscles; measurement of the size of the protrusion, examination of the fundus, biomicroscopy of the ocular media, tonometry, MRI and CT.

Treatment of endocrine ophthalmopathy:

Read more in our article about endocrine ophthalmopathy, treatment of pathology and recommendations from doctors.

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Causes, including after removal of the thyroid gland

Approximately 2% of the population suffers from soft tissue damage to the eyes, which is associated with autoimmune inflammation of the thyroid gland. It is more often found in women, with peak incidence observed at 10, 20, 40 and 60 years of age. Symptoms can develop simultaneously with a violation of hormone synthesis, precede dysfunction, or occur after 3-7 years of stable remission, as well as after incomplete removal of the thyroid gland.

It is characteristic that in 90% of patients with this pathology, low, normal hormone production is also found. If the background condition is autoimmune thyroiditis, then there is a fluctuation in the activity of the thyroid gland depending on the stage.

Provoking factors of ophthalmopathy:

• viral infections;
• irradiation, including ultraviolet radiation when sunbathing on the beach or in a solarium;
• smoking;
• contact with toxic substances at work;
• autoimmune lesions of joints, soft tissues, type 1 diabetes mellitus;
• genetic predisposition.

After such exposure, the cells of the immune system mutate and begin to destroy their own tissue of the eye muscles. The compounds formed in response (growth factors) stimulate the synthesis of substances that retain water in the tissues. This leads to swelling of the tissue behind the eyeball. At this stage, the changes are still reversible.

But over time, the edematous tissue begins to grow into connective tissue fibers with irreversible protrusion of the eyes, complications such as visual impairment, corneal ulcers, and false glaucoma.

The extended stage is characterized by a unilateral or asymmetrical anterior displacement of the eyeball (exophthalmos). Symptoms during this period of illness include:

• swollen eyelids, swelling does not decrease depending on the time of day and drinking regime;
• noticeable protrusion of the eyeballs (first degree up to 16 mm, second up to 20 mm, third over 20);
• headache;
• redness of the eyes;
• double contours of objects;
• it is impossible to close the eyelids completely.

In patients, these disorders lead to inflammation of the conjunctiva of the eyes, iris, corneal ulcers, and xerophthalmia (dry eyes). Swelling of the tissue puts pressure on the optic nerve, leading to decreased vision. Due to the restriction of eyeball movements, the outflow of intraocular fluid is disrupted with the development of false glaucoma and blockage of the retinal veins. Damage to the extraocular muscles causes strabismus.

Classification of endocrine ophthalmopathy

The disease manifests itself in three forms:

Forms of the disease	Symptoms
Thyrotoxic	Pathological shine, difficulty approaching when looking at a nearby point, protrusion anteriorly, the upper eyelid lags behind when lowering the eyes, pulling the eyelids upward (eyes slightly open during sleep), trembling.
Edema	The eyes are significantly displaced in front (more than 25 mm), the tissues around them are swollen (pronounced “bags” under and above the eyes), limited mobility, double vision, corneal ulcers when the eyelids do not close, pain in the eyes, congestion in the fundus.
Myopathic	The muscles that move the eyes are predominantly affected, it is difficult to look up and out, double vision, and the progressive destruction of muscle fibers causes severe strabismus.

Diagnosis of pathology

The patient should be examined by an ophthalmologist and an endocrinologist. The following examination plan is prescribed:

• blood test for antibodies to tissues, levels of thyroxine and triiodothyronine, thyroid-stimulating hormone of the pituitary gland;
• Ultrasound of the gland, if a node is detected, its puncture with cell examination (biopsy) is recommended;
• study of visual acuity, fields, function of the eye muscles;
• measuring the magnitude of protrusion (exophthalmometry), the angle of deviation for strabismus;
• fundus examination;
• biomicroscopy of ocular media;
• tonometry (determination of intraocular pressure) to exclude glaucoma;
• MRI and CT for differential diagnosis with tumors.

CT scan (signs of endocrine ophthalmopathy)

An important sign is a disruption of the immune system - a decrease in T-lymphocytes, an increase in antibodies: antinuclear, to thyroglobulin, tissue peroxidase, eye muscles, colloidal substance of the thyroid gland. If it is difficult to make a diagnosis, a biopsy of the eye muscles is prescribed.

Treatment of endocrine ophthalmopathy

The choice of treatment method depends on the stage of the disease, the nature of changes in hormonal activity (hyperthyroidism, hypothyroidism,).

Pulse therapy

Since this disease is an autoimmune disease, the most important method is the use of hormones from the glucocorticoid group (Metypred, Prednisolone, Dexamethasone). They have a suppressive effect on the formation of antibodies, reduce swelling and inflammation. The drugs are taken orally, injected, and less often injected behind the eyeball.

If there is a threat of blindness, pulse therapy with Metipred is prescribed. It involves the use of ultra-high doses over a short course. Patients receive 1000 mg of the drug per day intravenously for 5 days. Recent studies have found that if 1 g of methylprednisolone is administered once a week, the effectiveness of treatment is not reduced, and the risk of side effects (gastric and duodenal ulcers, hypertension, thrombophlebitis) is reduced.

Glucocorticoids are contraindicated in cases of exacerbation of peptic ulcer disease, acute pancreatitis, blood coagulation disorders, the presence of a tumor or mental disorder. For such patients, it is recommended that eye tissue be irradiated with X-rays, blood purification using plasmapheresis, cryoapheresis, immuno- and hemosorption.

Drug therapy

To correct hormonal disorders, Mercazolil, Espa-carb are used for excess production of thyroid hormones (thyrotoxicosis) and Eutirox for low activity (). Treatment is carried out until normal synthesis is achieved - the euthyroid state. If this cannot be done with the help of medications, the gland is removed, and the patient is prescribed hormones to replace the lost function.

To normalize metabolism in tissues, Actovegin and Solcoseryl are indicated in the form of eye gel, injections and tablets. To improve the functioning of the oculomotor muscles, Prozerin is administered. Vitamins A and E help restore the integrity of the membranes and prevent the formation of ulcers and dryness. Absorbable preparations (Lidase, aloe extract, enzymes) are also used for electrophoresis.

There are methods that are not among the main ones, but some patients have obtained convincing results. With the combined administration of Trental and Nicotinamide, it was possible to slow down the progression of ophthalmopathy by inhibiting the formation of mucopolysaccharide, which retains water in the periocular tissue. Somatostatin analogues (Lanreotide and Octreotide) block the activity of one of the growth factors that stimulates exophthalmos.

Surgery

Three methods can be chosen to treat patients:

• orbitotomy - one of the walls of the orbit of the eye and fiber are removed. This helps increase the volume of the eye socket. Indicated for signs of nerve compression, severe eye displacement;
• correction of the eye muscles is carried out in case of pain, double vision, strabismus, which cannot be alleviated with special glasses;
• Eyelid surgery is prescribed when the moving part is wrapped, spasm, or damage to the lacrimal glands.

Traditional methods

The disease is an autoimmune disease, so herbal remedies at best have no effect, and at worst cause rapid progression of symptoms. Traditional methods of treatment can lead to loss of time. In such cases, reversible eye damage is replaced by a stable pathology. In advanced forms of the disease, even the use of active hormonal therapy and surgery does not completely cure ophthalmopathy.

Eye damage in this disease is a secondary condition. The cause of ophthalmopathy is a malfunction of the thyroid gland and the body's immune system. Treatment of these disorders is possible only with hormonal therapy, surgery and radiation.

The earlier the disease is detected, the greater the chance of stopping its progression and restoring vision. Therefore, it is recommended that if visual discomfort occurs against the background of an enlarged thyroid gland, rapid pulse, sweating, or heart pain, immediately contact an ophthalmologist and endocrinologist and undergo a full course of treatment.

It is important to consider that any self-medication, use of medications and dietary supplements without prior examination and doctor’s recommendations can lead to complications. If for a number of factors there are different opinions regarding the influence on the development of the disease, then smoking is recognized as a reliable cause of severe forms of pathology.

For smokers, surgical treatment is not always effective. Quitting nicotine is considered mandatory for patients.

Watch the video about endocrine ophthalmopathy:

Endocrine ophthalmopathy and pregnancy

In general, the presence of thyrotoxicosis and ophthalmopathy is considered a factor leading to a severe course of pregnancy. But in some patients, the progression of the disease slows down due to the fact that the immune system is suppressed during this period. The most common eye symptoms include increased eye shine, exophthalmos, infrequent blinking, and darkening of the skin on the eyelids. The approach to treatment depends on the degree of disruption in the formation of thyroid hormones.

Severe unresolved thyrotoxicosis and high levels of antibodies to the thyroid gland are indications for stopping pregnancy. This is due to the fact that antibodies and hormones from the mother penetrate the placenta and the child is born with congenital thyrotoxicosis.

If a woman still plans to prolong her pregnancy, then drugs with an inhibitory effect are prescribed, most often Propicil, which penetrates the uteroplacental barrier to a lesser extent. Plant-based sedatives (infusion of motherwort and valerian) are indicated to alleviate cardiac and nervous system disorders.

Endocrine ophthalmopathy is damage to the tissues of the orbit of the eyes and eye membranes in diseases of the thyroid gland. The main reason for the development is the formation of antibodies to one’s own cells. It is characterized by exophthalmos, impaired eye mobility, difficulty in the outflow of ocular fluid, double vision, increased intraocular pressure, and decreased vision.

To make a diagnosis, an ophthalmological and endocrinological examination is performed. Intensive drug therapy is indicated; if ineffective, removal of the gland and corrective surgery are indicated.

The eyes are an important organ, without the normal functioning of which a full life is impossible. Correction of visual disturbances is carried out by ophthalmologists. But there are eye diseases that are treated simultaneously by different doctors.

What is the disease

Endocrine ophthalmopathy (orbitopathy) is a severe pathology in which endocrinologists and ophthalmologists provide assistance to the patient. The disease is of an autoimmune nature, most often occurs against the background of disorders of the thyroid gland and is a lesion of the subcutaneous tissue and muscles surrounding the eyeballs. The pathology was first described by Graves back in the century before last, so it is often called Graves' ophthalmopathy. Until recently, the disease was considered a symptom of toxic goiter, accompanied by increased production of thyroid-stimulating hormones and leading to thyrotoxicosis. Now endocrine orbitopathy is identified as an independent disease.

According to statistics, women get sick much more often than men, and people of forty or sixty years of age are affected. The medical literature describes cases of the disease in children. Mild forms of the disease are more common in young people; older people are characterized by the development of severe forms of ophthalmopathy.

Graves' orbitopathy manifests itself with characteristic signs and most often occurs against the background of pathologies of the thyroid gland

In 80–90% of cases, the disease occurs against the background of hormonal dysfunctions of the thyroid gland (hypothyroidism, autoimmune thyroiditis, thyrotoxicosis). In this case, eye manifestations can develop immediately with clinical symptoms of gland damage, or may precede them or even appear in the distant future (5-10 years after treatment of the thyroid gland). In 6–25% of cases, ophthalmopathy can occur against the background of euthyroidism (a condition in which the thyroid gland works correctly and the level of thyroid hormones is normal).

Causes of the disease

The exact causes of Graves' ophthalmopathy are still unclear. Factors that can trigger pathology are:

• bacterial or viral infections;
• solar and radiation radiation;
• stressful situations;
• smoking;
• poisoning with salts of heavy metals;
• autoimmune pathologies, for example, diabetes.

The mechanism of development of the disease is as follows: as a result of spontaneous mutations, the immune system begins to perceive the fiber located around the eyeballs as having receptors for thyroid hormones, and produces specific proteins - antibodies to them. The latter, entering the orbital (orbital) tissue, cause a reaction that occurs with the release of special substances - cytokines that stimulate the production of glycosaminoglycans, proliferation (increased division) of fibroblasts and collagen synthesis. Glycosaminoglycans are able to bind fluid, which causes swelling and a significant increase in the volume of fiber and eye muscles, which leads to exophthalmos - protrusion of the eyes. Over time, the inflammation subsides, swelling and infiltration of the periorbital tissues are replaced by scar tissue, and bulging eyes become irreversible.

The development of the clinical picture of the disease is based on complex autoimmune processes

With hyperthyroidism (increased levels of thyroid hormones), the pathological process is aggravated. About 80% of patients present with the problem of exophthalmos after long-term therapy for hyperthyroidism.

Some patients become ill after surgery to completely remove the thyroid gland. With hypothyroidism (reduced gland function and lack of hormones), the mechanism of disease development is somewhat different. Normally, the hormone triiodothyronine inhibits the production of mucopolysaccharides (glycosaminoglycans) by fibroblasts. With a lack of hormone, the inhibitory (depressant) effect is reduced and fibroblasts are activated.

Doctor about Graves' ophthalmopathy

Classifications of the disease

Modern ophthalmology operates with several classifications of pathology depending on the clinical course and severity of symptoms.

Classification according to Baranov:

• 1st degree - exophthalmos (bulging eyes) up to 16 mm, moderate swelling of the eyelids, the functions of the conjunctiva and eye muscles are not impaired;
• 2nd degree - exophthalmos up to 18 mm, severe swelling of the conjunctiva and eyelids, periodic diplopia (double vision);
• 3rd degree - exophthalmos up to 21 mm, eyelids do not close completely, ulcers and erosions form on the cornea, the eye is limited in movement, symptoms of optic nerve atrophy.

The disease can occur in several forms:

• thyrotoxic exophthalmos - manifests itself as true or false bulging eyes without affecting eye mobility, upward displacement of the upper eyelid (while the upper part of the sclera is exposed), tremor (shaking) of closed eyes, while visual functions are never impaired;
• edematous exophthalmos - characterized by bulging eyes up to 30 mm, severe tissue swelling, impaired mobility of the eyeballs, diplopia (double vision); Depending on which structures are involved in the pathological process, there are 3 variants of the edematous form:
  • lipogenic, in which the orbital tissue suffers;
  • myogenic, when the eye muscles are affected;
  • mixed, in which fiber and muscles are involved in the process; myogenic and mixed forms lead to a sharp deterioration of vision;
• endocrine myopathy - manifested by weakness of the eye muscles, which leads to diplopia, impaired movement of the eyeballs, and strabismus.

During Graves' ophthalmopathy there are 3 phases:

• inflammatory exudation;
• infiltration;
• proliferation and fibrosis.

Symptoms of the disease

Manifestations of the disease differ depending on the form and underlying pathology that provoked ophthalmopathy.

The clinical picture of thyrotoxic exophthalmos consists of protrusion, often slight, of both eyes, an increase in the palpebral fissure, while the patient may complain of a feeling of dryness, sand in the eyes, and morning swelling under the eyes. Other manifestations are associated with the toxic effect of thyroid hormones (sleep disturbance, anxiety, mood swings, headaches, palpitations). As a rule, women suffer.

Thyrotoxic exophthalmos is manifested by protrusion of the eyes without visual impairment

With edematous exophthalmos, both eyes are affected, often at different times - first one, and after a while the other. In its development, this form of the disease goes through three stages:

1. The first stage (compensation) is manifested by some drooping of the upper eyelid and slight swelling around the eyes in the morning, which disappears during the day. The eyes close completely; the patient complains of intermittent discomfort in the eyes, dryness or lacrimation, photophobia. Exophthalmos gradually develops.
2. The next stage is subcompensatory. It is characterized by a rapid increase in exophthalmos, increased intraocular pressure, and the development of chemosis (edema of the conjunctiva). Swelling of the periorbital tissues becomes permanent; symptoms of dryness and irritation of the eyes also do not go away during the day. The patient cannot close his eyelids completely, his eyes turn red, as the vessels of the sclera dilate, become tortuosity, and conjunctivitis develops. Chronic headaches are added.
3. During the decompensation stage, there is a sharp increase in symptoms. The bulging eyes are very pronounced; the patient is unable to close his eyes due to severe swelling of the eyelids and surrounding tissue. Movements of the eyeballs are severely limited and painful. Swelling of the optic nerve gradually develops, erosions and ulcers form on the cornea. The patient suffers from a sharp deterioration in vision and diplopia. If he does not receive treatment, then this stage can end with fibrosis (scarring) of the orbital tissues and a decrease in vision up to its loss.

Edema exophthalmos threatens the development of severe complications including loss of vision

Against the background of hypothyroidism (sometimes after surgical removal of the thyroid gland) or euthyroidism, endocrine myopathy occurs. This form of the disease most often affects men, is bilateral in nature and tends to develop rapidly. The acute phase of infiltration is very short and the periorbital tissues are soon affected by fibrosis. From the very beginning of the disease, patients complain of diplopia, which rapidly increases. There is usually no swelling in this form, but bulging eyes quickly develop, the eyes are limited in movement due to hypertrophy (thickening) of the eye muscles, visual acuity is significantly reduced, and strabismus may appear.

Endocrine myopathy may be complicated by strabismus

Diagnosis of pathology

To make a diagnosis, the patient must undergo an ophthalmological and endocrinological examination.

The endocrinologist prescribes an ultrasound examination of the thyroid gland to the patient. If large nodes are detected, a puncture biopsy is performed with histological examination of the material. To clarify the functional capacity of the gland, the patient undergoes tests for thyroid hormones and antibodies to its tissues.

When examining a patient, the ophthalmologist aims to visualize the structures of the visual organs and evaluate visual functions. For this purpose the following is carried out:

• visometry (examination using tables);
• perimetry (study of the boundaries of visual fields);
• assessment of the motor abilities of the eyeballs;
• exophthalmometry and measurement of the angle of hypertropia (squint) to determine the degree of protrusion and deviation of the eyeballs;
• ophthalmoscopy (examination of the fundus of the eye) to assess the condition of the optic nerve;
• biomicroscopy - to determine the condition of the remaining structures of the eye;
• tonometry - to measure intraocular pressure.

Ultrasound examination, magnetic resonance or computed tomography are carried out to differentiate the disease from neoplasms of the periorbital tissue.

To clarify the degree of destructive processes in the periorbital tissues, MRI is used

An important stage of diagnosis is assessing the patient’s immune status; for this purpose, blood is donated for an immunogram.

Once the diagnosis is made, it is important to determine the clinical activity of the disease. The CAS scale is used for this:

1. Painful pressure behind the eyeballs for the past month.
2. Painful sensations when trying to change the direction of gaze.
3. Hyperemia (redness) of the eyelids.
4. Swelling.
5. Redness of the mucous membrane of the eyes.
6. Chemosis is swelling of the conjunctival membrane.
7. Swelling of the caruncle (tear caruncle).

Activity is assessed in points - 1 point corresponds to 1 symptom. The overall score can range from 0 (inactive phase) to 7 (pronounced). The disease is considered active when the score is above 4 points.

Differential diagnosis

The pathology should be distinguished from other diseases - neoplasms (especially when one eye is affected by ophthalmopathy), pseudoexophthalmos with a high degree of myopia, optic neuropathy arising for other reasons, orbital phlegmon, myasthenia gravis.

Treatment

Medical tactics depend on the degree of thyroid disorders, the form and activity of the disease. Main goals of therapy:

• moisturizing the mucous membrane of the eye;
• prevention of keratopathy (pathological changes in the cornea);
• normalization of intraocular pressure;
• elimination or at least stabilization of destructive intraocular processes;
• preservation of vision.

Regardless of the form of the pathology, the patient is given general recommendations:

• mandatory cessation of active and passive smoking, since tobacco smoke is a proven trigger (provoking factor) for the development of endocrine ophthalmopathy;
• use of symptomatic external agents: drops and gels to moisturize the mucous membrane of the eyes;
• wearing tinted glasses;
• normalization of thyroid function.

A close connection with tobacco smoking is a feature of Graves' ophthalmopathy. In patients who have a bad habit, the manifestations of pathology are more pronounced compared to patients who lead a generally healthy lifestyle. The risk of developing complications in smokers is almost five times higher.

Smoking increases the risk of developing complications of ophthalmopathy several times

Conservative treatment

Correction of thyroid function is carried out by an endocrinologist: for hyperthyroidism, thyreostatics are prescribed, for hypothyroidism - thyroxine. If drug therapy does not have the desired effect, the patient is offered surgery to remove a section or the entire gland.

A mandatory component of treatment is the use of steroids. Most often, the patient is prescribed Methylprednisolone, Metimpred, Diprospan, Kenalog according to an individual regimen. Glucocorticoids have anti-edematous, anti-inflammatory and immune suppressive effects.

If there is a threat of vision loss, the patient is prescribed pulse therapy with prednisolone or methylprednisolone. This treatment consists of intravenous administration of ultra-high doses of the drug for 3 days. Starting from the 4th day, the patient is transferred to taking a tablet form of the drug with a gradual reduction in dose. At the same time, accompanying symptomatic treatment is carried out. Pulse therapy has contraindications: acute infectious diseases, severe renal and liver dysfunction, glaucoma, high blood pressure, diabetes, gastric and duodenal ulcers.

Pulse therapy with prednisolone is recognized as an effective treatment for endocrine ophthalmopathy

In addition to intramuscular and oral (internal) use of hormonal drugs, the retrobulbar administration technique is widely used. However, foreign clinics refuse this method due to its high trauma and high risk of complications in the form of scar formation at injection sites.

An alternative to steroids is the immunosuppressant Cyclosporine, which is prescribed either alone or in combination with steroids. In addition to hormones, in severe cases, X-ray irradiation of the orbits is used (often in combination). The patient can also be prescribed hemosorption, plasmapheresis, cryopharesis, which significantly reduce inflammatory changes.

As part of symptomatic therapy, drugs are selected for the patient to normalize metabolic processes and neuromuscular transmission - Actovegin, Taufon, Aevit, Phlebodia 600, Proserin.

To moisturize the mucous membrane of the eyes, artificial tears, moisturizing drops, ointments and gels are used: Carbomer, Oftagel, Vidisik, Korneregel. In order to prevent keratitis (inflammation of the cornea), drops with glucose, vitamins B2, C are prescribed. For conjunctivitis, antibacterial drops (Levomycetin, Ofloxacin), Albucid, furacillin are needed.

To moisturize the cornea, the patient must be prescribed special products, such as artificial tears

Physiotherapeutic methods include magnetic therapy on the orbital area, electrophoresis with aloe, lidase, trypsin, hydrocortisone, and hyaluronidase.

Surgery

In severe cases, the patient may be prescribed surgical treatment. The operation is performed in the stage of subsiding of acute inflammation or in the stage of scarring. For Graves' ophthalmopathy, various surgical options can be used: orbital decompression, eyelid or extraocular muscle surgery. Sometimes several surgical interventions are performed sequentially:

• Decompression is necessary for severe exophthalmos, optic neuropathy, and keratitis. The intervention aims to increase the volume of the orbit, while one or more of its walls are excised, and retrobulbar (located behind the orbit) tissue is removed.
• Surgery on the eye muscles is performed for the development of paralytic strabismus and persistent diplopia.
• Operations on the eyelids can be performed using various methods and depend on the nature of the disorder, which may include: retraction (reduction of the eyelid due to contraction), entropion of the eyelid, damage to the lacrimal gland, lagophthalmos (non-closure of the eyelids). To lengthen the upper eyelid, surgery is performed on the levator muscle.
• Blepharoplasty is often the final stage of surgical treatment.

Possible complications of the operation may be decreased or loss of vision, bleeding, diplopia, disruption of the symmetry of the eyelids and eyeballs, loss of sensitivity in the area of ​​intervention, and sinusitis.

Video: ophthalmologist about surgical treatment of the disease

Application of traditional methods

Endocrine ophthalmopathy cannot be treated with folk remedies. Therapy is always carried out within the framework of traditional medicine. Herbal treatment may provide some benefit in terms of normalizing euthyroid status. It is for this purpose that some traditional medicine recipes can be used.

For hypothyroidism, the following remedies can be used.

A collection of rowan fruits, elecampane root, St. John's wort and birch buds:

1. Take the raw materials in equal parts - 1 large spoon.
2. Pour boiling water over it and boil for 5 minutes, preferably in a water bath.
3. Leave for at least 6 hours. Take 50 ml or 3 tablespoons three times a day half an hour before meals.

A collection of budra, rowan blossom, strawberry leaves, thyme and woodlice:

1. Mix herbs in equal proportions.
2. Pour one large spoonful of the mixture into a glass of boiling water and leave for half an hour.
3. Take 100 g of medicine in the morning before breakfast.

Collection with nettle, eleutherococcus and dandelion root, cocklebur and carrot seeds:

1. Raw materials must be taken in equal parts.
2. Pour two tablespoons of the mixture with water in a volume of 500 ml, boil for 7–10 minutes.
3. Leave for 15–20 minutes and strain.
4. Take 80 ml decoction 4 times daily before meals.

Other herbs are effective for hyperthyroidism.

White cinquefoil decoction:

1. Pour 20 g of root into a glass of water and boil in a water bath for 8–10 minutes.
2. Leave for half an hour, strain.
3. Take 1 teaspoon three times a day 15–20 minutes before meals.

Hawthorn tincture:

1. Mash hawthorn berries, pour half a glass of raw material with 70% alcohol (100 ml).
2. Leave the mixture in a dark place for 20 days, shaking occasionally.
3. Strain the finished tincture and take in the dosage prescribed by your doctor.

Motherwort tincture (can be purchased ready-made at the pharmacy):

1. Mix 20 g of crushed raw materials with vodka (100 ml).
2. Leave in a cool, dark place for 2 weeks, filter.
3. Take 30 drops 3-4 times daily.

For thyrotoxicosis, it is useful to drink a rosehip decoction and a lemon-honey drink: pour the peel of one fresh lemon with a liter of boiling water, boil and add a spoonful of honey, then cool and drink instead of tea.

Photo gallery: unconventional methods of treatment

Eleutherococcus root separately and in collections is used for decreased thyroid function
Hawthorn fruit tincture is recommended for hyperthyroidism
Potentilla root is used in the complex treatment of thyroid diseases, accompanied by increased production of hormones.
Chickweed herb is included in preparations for the treatment of low thyroid function
Motherwort herb is prescribed as a symptomatic remedy for thyrotoxicosis.
Rowan fruits are recommended for insufficient thyroid function

Other techniques

To reduce swelling, the patient can undergo lymphatic therapy, which consists of sequential subcutaneous injection into the periorbital area of ​​Heparin, Chymotrypsin and Lasix with the addition of Novocaine. The combined effect of the drugs enhances lymphatic drainage and reduces swelling.

Currently, clinical studies are being conducted on new methods of treating Graves' ophthalmopathy, which include the use of selenium, Rituximab (cytostatic), cytokine inhibitors (immunomodulators) - Daclizumab, Enbrel, Remicade.

There are methods of therapy that, although not basic, can significantly improve the condition of a patient with ophthalmopathy. For example, Pentoxifylline and Nicotinamide, Octreotide, Lanreotide, Tsiamexon, immunoglobulins. These drugs help stabilize the patient’s condition and reduce the severity of symptoms (edema, exophthalmos, tissue infiltration).

Treatment prognosis and possible complications of the disease

The prognosis directly depends on the time of treatment started. If adequate therapy was carried out in the early stages, it is quite possible to achieve long-term remission and avoid irreversible consequences. According to statistics, about 30% of patients experience improvement, and in 60–70% of patients the process stabilizes. After the course of treatment, the patient is registered with an ophthalmologist and endocrinologist with mandatory monitoring after 6 months.

Delayed and incorrect therapy can lead to complications:

• decreased visual acuity;
• papilledema and blindness;
• strabismus;
• severe keratopathies (ulcers, erosions, perforation of the cornea).

Disease prevention

There is no specific prevention of the disease. Preventive measures include:

• timely diagnosis and complete treatment of thyroid disorders;
• immediately contact an ophthalmologist if vision problems occur - double vision, decreased visual acuity, bulging eyes, redness and soreness of the eyes;
• maintaining a healthy lifestyle - mandatory cessation of smoking and strengthening the immune system.

Timely contact with an ophthalmologist is the key to successful treatment of endocrine ophthalmopathy