Survey highlights mental health impact of thyroid eye disease
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The increased focus on mental health amid the COVID-19 pandemic provides an important reminder to take stock of our patients’ mental health, as well as their physical health. This is especially critical for patients living with thyroid eye disease.
A newly published survey of U.S. physicians who treat patients with this serious autoimmune disease, that threatens vision and can lead to permanent facial disfigurement, found that thyroid eye disease has a devastating impact on patients’ mental health and overall quality of life.
The survey queried 181 physicians to better understand how they perceive the quality of life of their patients with thyroid eye disease, a progressive disease characterized by eye bulging, double vision, blurred vision, pain and inflammation. Thyroid eye disease most often occurs in patients with Graves’ disease, but has a separate pathology. The condition is caused by autoantibodies activating an IGF-1R mediated signaling complex on cells within the retro-orbital space. If left untreated, it can cause long-term, irreversible damage to vision and appearance.
The survey addressed overall quality of life, ability to attend work/school, ability to function in social situations, ability to participate in and enjoy day-to-day activities, ability to drive, and psychological well-being. A total of 73 endocrinologists and 108 ophthalmologists participated in the online survey, reporting insights from 714 patients with thyroid eye disease. Results showed that thyroid eye disease has a significant burden on patients’ mental health and quality of life. Among the key findings:
Patients’ psychological well-being and ability to function in social situations are most impacted by thyroid eye disease.
More than one-third of patients with thyroid eye disease (36.4%) had anxiety and depression — nearly twice the rate of the U.S. adult population in 2017 (18.9%).
Strabismus, diplopia and ocular pain had the highest impact on patients’ quality of life. These thyroid eye disease symptoms are also often drivers of mobility restrictions or occupational disability.
The survey results underscore how important it is for physicians to recognize the nonphysical effects of thyroid eye disease and take these into consideration when determining how to treat their patients. This more holistic approach can be accomplished by establishing dialogue early on with patients to help identify the impact of the disease on emotional well-being. Reserving time during office visits or telehealth appointments to ask open-ended questions about mental health, daily functioning, and ability to work are just some of the ways for clinicians to better understand the overall impact and burden thyroid eye disease may be having on a patient.
For patients needing mental health support, a referral to a mental health specialist can help ensure they receive the appropriate treatment, therapy and/or counseling. Keeping this type of dialogue open can help increase a patient’s comfort in seeing a mental health professional and reduce stigma.
In summary, thyroid eye disease is a challenging disease for patients physically and emotionally. It can reduce a patient’s independence, ability to work, and self-confidence — three things that are vital to a person’s wellbeing. As clinicians, we are in a unique position to provide holistic care to these individuals, looking beyond the physical aspects of the disease. By devising a treatment plan for patients’ physical symptoms to prevent irreversible damage and connecting them to the support and resources they need to address any mental health obstacles they might have, we can help them preserve their quality of life and live a full life.
For more information:
Yao Wang, MD, is a neuro-ophthalmology and oculoplastic specialist at Cedars-Sinai Medical Center in Los Angeles. She can be reached at wangx699@gmail.com.
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