Month: December 2022

Perhaps you’ve seen this ad about a drug for thyroid eye disease. If so, you may be wondering what thyroid eye disease is — and why the woman in the ad is wearing five pairs of sunglasses at once. Read on for answers.

What is thyroid disease and how does it affect the eyes?

The thyroid gland is a small, butterfly-shaped organ at the front of the neck. It releases thyroid hormone, which helps control many functions in the body. If it releases too much thyroid hormone (hyperthyroidism) or too little (hypothyroidism), bothersome and sometimes serious symptoms may develop, including changes in muscle strength, bowel function, and heart function.

An overactive thyroid gland can cause thyroid eye disease, prompting swelling and inflammation in tissues surrounding the eyes. The condition causes bulging eyes, a dry, gritty sensation in the eyes, tearing, pressure or pain behind the eyes, and blurring or double vision.

As many as half a million people in the US have thyroid eye disease. It affects up to half of people with Graves’ disease, an autoimmune illness marked by an overactive thyroid.

Thyroid eye disease ad: The pitch and the evidence

The ad opens with a woman wearing large, dark sunglasses, identified as a real patient named Jeanne. “With thyroid eye disease,” she explains, “I was always wearing sunglasses to hide my bulging eyes. I wore them just about everywhere.”

She removes her sunglasses to reveal that she’s wearing another pair underneath. In fact, she’s wearing three pairs of sunglasses and later will be wearing five!

As the music turns upbeat, she continues: “But then my doctor recommended Tepezza, a prescription medicine for thyroid eye disease, and I didn’t have to hide so much.”

A drawing of a bulging eye morphing into a more normal eye accompanies her next words: “In a clinical study, more than eight out of 10 patients taking Tepezza had less eye bulging. And nearly seven out of 10 saw improvements in double vision.”

Warnings about this medicine

You know what comes next: a fast-talking voiceover warning of possible side effects. For Tepezza, these include:

• Infusion reactions. Now we learn that Tepezza is an intravenous (infused) medicine. A course of treatment is eight 90-minute infusions, each separated by three weeks. Infusion reactions may be mild or severe, including allergic reactions (such as itching or hives) and other side effects that occur during or just after the infusion (such as fever or sweats).
• When to call for advice. “Tell your doctor right away if you have symptoms such as high blood pressure, fast heartbeat, shortness of breath, or muscle pain,” the voiceover instructs. Keep in mind that most people with high blood pressure have no symptoms, but if severe it can cause headaches, blurry vision, or chest pain.
• Before starting treatment. If you have diabetes or inflammatory bowel disease, or if you are pregnant or planning to become pregnant, you should tell your doctor before starting treatment. That’s because Tepezza may harm a developing fetus or worsen other diseases.

A big finish: Controlling thyroid eye disease

As the commercial winds down, Jeanne is back, removing her fifth consecutive pair of sunglasses to reveal normal-appearing eyes. “I look more like my old self again. Now I wear sunglasses because I want to.”

“Ask your doctor if Tepezza is right for you,” the narrator advises before suggesting a visit to the website for before and after pictures of Jeanne. I checked; they’re impressive.

What the ad gets right

The ad accurately describes

• thyroid eye disease symptoms
• how the condition alters appearance and can cause embarrassment
• results of a single, small study investigating the risks and benefits of Tepezza.

What else do you need to know about treatments for thyroid eye disease?

• You must treat thyroid disease as well as your eye condition. Medicines or surgery are often good options. Radiation therapy may be effective, but sometimes makes thyroid eye disease worsen.
• Selenium, a mineral supplement, is recommended by some experts.
• Quitting smoking is always recommended, partly because smoking may worsen thyroid eye disease.

If thyroid eye disease is mild, moisturizing eye drops, eye shades or patches, or dark sunglasses may be sufficient.

If thyroid eye disease is moderate to severe, options include:

• medicines that suppress inflammation or an overactive immune response. Examples include glucocorticoids, teprotumumab (Tepezza), mycophenolate mofetil (Cellcept), tocilizumab (Actemra), or rituximab (Rituxan).
• surgery to remove excess tissue around the eyes.

Small studies, like the one cited in the ad, may not detect all side effects, especially rare ones.

Last, but certainly not least: Tepezza is expensive. The price for a year of treatment can be $300,000 or more — and insurance coverage varies.

The bottom line

I still don’t know why the woman in the ad wears multiple pairs of sunglasses at the same time. Maybe it’s to emphasize how serious she is about hiding her eyes. Or maybe it’s just a way to grab our attention. Direct-to-consumer drug marketing strategies can be even more mysterious than the illnesses they hope to treat.

If you’re concerned you may have thyroid disease or thyroid eye disease, talk to your doctor. A costly new drug may be an option for some people, but it pays to learn about all options. Academic medical centers, the NIH, or a medical society are more likely to give you reliable and balanced information than a drug ad.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD

Dementia poses many challenges, both for people struggling with it and for those close to them. It can be hard to witness and cope with common behaviors that arise from illnesses like Alzheimer’s disease, vascular dementia, or frontotemporal dementia.

Caring for a person who has dementia may be frustrating, confusing, or upsetting at times. Understanding why certain behaviors occur and learning ways to handle a variety of situations can help smooth the path ahead.

What behaviors are common when a person has dementia?

People with dementia often exhibit a combination of unusual behaviors, such as:

• Making odd statements or using the wrong words for certain items.
• Not realizing they need to bathe or forgetting how to maintain good hygiene.
• Repeating themselves or asking the same question over and over.
• Misplacing objects or taking others’ belongings.
• Not recognizing you or remembering who they are.
• Being convinced that a deceased loved one is still alive.
• Hoarding objects, such as mail or even garbage.
• Exhibiting paranoid behavior.
• Becoming easily confused or agitated.
• Leaving the house without telling you, and getting lost.

Why do these behaviors occur?

Inside the brain of a loved one with dementia, picture a wildfire shifting course, damaging or destroying brain cells (neurons) and neural networks that regulate our behavior.

What drives this damage depends on the underlying cause, or causes, of dementia. For example, while the exact cause of Alzheimer’s disease is not known, it is strongly linked to proteins that are either gunking up or strangling brain cells. Someone with vascular dementia has experienced periodic insufficient blood flow to certain areas of the brain, causing neurons to die.

“As dementia progresses, the person loses brain cells associated with memory, planning, judgment, and controlling mood. You lose your filters,” says Dr. Stephanie Collier, a psychiatrist at Harvard-affiliated McLean Hospital.

Six strategies for coping with dementia-related behaviors

Dealing with distressing or puzzling dementia-related behavior can require the type of tack you’d take with a youngster. “Due to declines, older adults with dementia can seem like children. But people are generally more patient with children. You should consider using that approach with older adults,” suggests Lydia Cho, a McLean Hospital neuropsychologist.

• Don’t point out inaccurate or strange statements. “It can make people with dementia feel foolish or belittled. They may not remember details but hold onto those emotions, feel isolated, and withdraw. Instead, put them at ease. Just go with what they’re saying. Keep things light,” Cho says.
• Don’t try to reason with the person. Dementia has damaged your loved one’s comprehension. Attempting to reason might be frustrating for both of you.
• Use distraction. This helps when the person makes unreasonable requests or is moderately agitated. “Acknowledge what the person is saying, and change the activity. You could say, ‘I see that you’re upset. Let’s go over here for a minute.’ And then do an activity that engages the senses and relaxes them, such as sitting outside together, listening to music, folding socks, or eating a piece of fruit,” Dr. Collier says.
• Keep unsafe items out of sight. Put away or lock up belongings the loved one shouldn’t have — especially potentially dangerous items like car keys or cleaning fluids. Consider installing cabinet locks.
• Supervise hygiene routines. The person with dementia might need a reminder to bathe, or might need to have the day’s clothes laid out on the bed. Or you might need to assist with bathing, shaving, brushing teeth, or dressing.
• Spend time together. You don’t have to convince your loved one of your identity or engage in fascinating conversation. Just listen to music or do some simple activities together. It will help keep the person from withdrawing further.

Safety is essential when a person has dementia

Sometimes simple strategies aren’t enough when a loved one has dementia.

For example, if the person frequently tries to leave home, you might need to add child-proof covers to doorknobs, install additional door locks or a security system in your home, or get the person a GPS tracker bracelet.

If the person is frequently upset or even violent, you’ll need to call the doctor. It could be that a new medical problem (such as a urinary tract infection) is causing agitation. “If the agitated behavior isn’t due to a new health problem and is predictable and severe, we might prescribe a medication to help regulate mood, such as an antidepressant or an antipsychotic in cases of extreme agitation or hostility,” Dr. Collier says.

As dementia changes, seek the help and support you need

No one expects you to know how to interact with someone who has dementia. There’s a learning curve for all of us, and it continues even after you get a feel for the situation. “The process keeps changing,” Cho says. “What works today may not work next week or the week after that for your loved one. So keep trying different strategies.”

And get support for yourself, such as group therapy for caregivers and their families. You can also find information at the Alzheimer’s Association or Family Caregiver Alliance.

About the Author

Heidi Godman, Executive Editor, Harvard Health Letter

Heidi Godman is the executive editor of the Harvard Health Letter. Before coming to the Health Letter, she was an award-winning television news anchor and medical reporter for 25 years. Heidi was named a journalism fellow … See Full Bio View all posts by Heidi Godman

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Howard LeWine, M.D., is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD