Illustrating the Progression of Thyroid Eye Disease

Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit.Endocrinologist and food artist Malini Gupta, MD, depicts the progression of thyroid eye disease in this series. It was made using Korean radish; turnip; peach; kiwi; blueberry; tapioca colored with blue spirulina; lotus root; strawberry; cucumber; and orange, yellow, and black carrots.

Immunoglobulins against insulin-like growth factor 1 receptors activate signaling in the orbital fibroblasts. The fibroblasts then produce hyaluronan and the cytokines interleukin -1 beta, IL-6, IL-8, IL-16, tumor necrosis factor alpha, and CD4 ligand. The cytokines and hyaluronan expand the orbital tissue, muscles, and fat by drawing water into these tissues.

The globe proptosis leads to conjunctival irritation and dryness. Acinar cells of the lacrimal glands express thyroid-stimulating hormone receptors. The TNF-alpha binds and results in altered regulation of pro-inflammatory and protective proteins. This changes the tear film. Changes in thyroid eye disease can be unilateral or bilateral. Changes in thyroid eye disease are often gradual but can cause extensive quality-of-life changes. These can impact patient's activities, appearance, and self-confidence.

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