The Arched Rainbow Brow in Thyroid Eye Disease

[helvella]

I had never heard of Rainbow Brow. Anyway, just of general interest - probably mostly to those who are unfortunate enough to have TED.

Ophthalmic Plast Reconstr Surg. 2022 Mar 30.

doi: 10.1097/IOP.0000000000002168. Online ahead of print.

The Arched Rainbow Brow in Thyroid Eye Disease

Ann Q Tran 1 , Cameron Yang 2 , Andrea A Tooley 3 , Marielle Mahan 4 , Emery C Jamerson 1 , Michael Kazim 1 , Lora R Dagi Glass 1

• PMID: 35353778

• DOI: 10.1097/IOP.0000000000002168

Abstract

Purpose: To morphologically describe and mathematically quantify a novel clinical feature of thyroid eye disease (TED).

Methods: A retrospective study was conducted of TED patients and age-sex-matched normal controls. The arched Rainbow Brow appearance in TED patients was determined by unanimous agreement of 3 oculoplastic surgeons. Eyebrow curvature was assessed by plotting 15 points along the eyebrow in ImageJ. The fourth-degree polynomial (y = ax + bx + cx + dx + e) was fitted to each eyebrow.

Results: Two hundred seventy-one eyes were analyzed (200 TED and 71 age-sex-matched normal controls). A Rainbow Brow was identified in 42% of TED patients. A unilateral Rainbow Brow was seen in 15% of patients. The fourth-degree polynomial coefficients yielded significant differences between Rainbow Brow patients and age-sex-matched normal controls for the coefficients a, b, c, and d. Similar analysis of TED patients with and without a Rainbow Brow showed differences in coefficients a and b. Age >50 years (p = 0.009) and the presence of brow fat expansion (p < 0.001) were associated with the presence of a Rainbow Brow. Proptosis >24 mm showed a trend toward association with the presence of a Rainbow Brow (p = 0.057). When considering the contribution of these features in a multivariable analysis, only brow fat expansion was a significant contributing factor (p = 0.009).

Conclusions: The Rainbow Brow is a distinct entity in TED and is likely consequent to brow fat pad expansion. Patients with a Rainbow Brow have different eyebrow curvature as compared to both normal age-sex-matched controls and TED patients without a Rainbow Brow.

pubmed.ncbi.nlm.nih.gov/353...

An earlier Open Access paper which includes a photo demonstrating what is meant by Rainbow Brow in TED.

The Rainbow Brow in Thyroid Eye Disease

iovs.arvojournals.org/artic...

Edited to add a picture illustrating a rainbow brow.

[amala57]

This is curious. I have mild TED, & on & off I have what I call kaleidoscope vision.When I asked my optician about this he said it was a pain free migraine.

I wonder if this is the same thing.

It is usually triggered by bright light, either sun or computer screen & I have, for approximately half an hour, an arc of kaleidoscope colours that blocks my vision in one eye. Is this arc my eyebrow?

Am I understanding this correctly?

Anyway, thanks for posting.

[RedApple in reply to amala57]

amala57, I have what I call kaleidoscope vision.When I asked my optician about this he said it was a pain free migraine.

I think your optician is probably right. I get this (also known as 'visual migraines') when my FT4 level is too high for me.

The article helvella has posted is misleading. The term rainbow seems to refer to the brow shape, and not the colours as we would automatically assume!

[helvella in reply to RedApple]

I agree that the title of the paper draws us to think of rainbow colours.

[RedApple in reply to helvella]

When I saw the title, I couldn't figure out how eyebrow hair could possiblybecome rainbow coloured!

[helvella in reply to RedApple]

Apologies - I couldn't resist! 🌈🏳️‍🌈

Rainbow coloured eyebrows (not what is being discussed)

[RedApple in reply to helvella]

Needs rainbow lashes to compliment the brows 🤣

[helvella in reply to RedApple]

Probably best if they are on the same person, but...

Rainbow dyed eyelashes.

[RedApple in reply to helvella]

Very pretty, but as you say, should be on the same person as the brows

[Rapunzel in reply to helvella]

Yeah baby, yeah I'll have the lashes, too. I didn't know that you were an eyebrow technician, Rod 🤩

[amala57 in reply to RedApple]

Thank you for clarification

[helvella in reply to amala57]

I too get something like that. There are many mock-ups available online if you search for migraine with aura, painless migraine, and similar terms - switch to image search!

Yes - about half an hour. And often feel a bit wiped out for a few hours afterwards.

But this paper is about the shape of the actual hairs in the brow.

[amala57]

Thank you for clarification

[pennyannie]

Well, I'm sorry but have to say but - Have they nothing better to do with their time ??

Having been refused treatment for my eye issues after RAI thyroid ablation as they were deemed not bad enough - the psychological impact for the patient is not even given a thought.

My lost eyebrows are now manmade and a tattoo so I guess another issue to be filed away :

Sorry - rant over :

[helvella in reply to pennyannie]

Very much understand, but is it possible that knowing this seemingly unimportant, or at least ignored, facet, will help in several ways? Such as initial diagnosis, decisions on precise details when intending to operate, etc.?

[pennyannie in reply to helvella]

Are you serious or is this a joke !!

You've got me laughing however !!!

[TSH110 in reply to helvella]

It is very interesting perhaps some specialists will use it in the future. It could be subtle things like this this explain why careful visual observation of the patient can lead to diagnosis of thyroid disease which is sadly overlooked in favour of blood test numbers which aren’t even calibrated to one another if analysed by different methods 😖😖😖

My eyebrows do seem rather like the shot of rainbow brow. I may try a superimposition to see how closely they match as I’m suspicious I have TED.

Turns out it’s a very close match indeed 😳

Rainbow brows?

[asiatic]

Don't see this catching on as many thyroid patients don't have any eyebrows. It was loss of eyebrows that first took me to my GP. TED followed 2 years later. If doctors aren't aware about loss of eyebrows I can't imagine this new info will have them whipping out their protractors and using an equation to diagnosis us 🤣

[TSH110 in reply to asiatic]

I wonder what mine would say if I took my superimposition and said my rainbow brows are indicative of TED! Please can you test for relevant antibodies?

[PurpleNails Administrator in reply to TSH110]

Graves can occur without TED and it can occur without antibody formation too according to this article.

“TED can present independent of Graves & endocrinologic manifestations or autoantibody formations”

ncbi.nlm.nih.gov/pmc/articl...

But having positive antibodies would be a good clue.

[TSH110 in reply to PurpleNails]

They thought I had graves first blood test but a week later I was extremely hypothyroid. I had atropic autoimmune thyroiditis and TED is quite common with it as it had the same antibodies as graves, I think it’s TRAB. I though I had TED but it was never diagnosed. I had a bad ptosis on one eye that was investigated for myasthenia gravis. A few here have said better optimisation of thyroid hormones got rid of theirs, mine greatly improved when I started in NDT and I felt hugely better in every way. Tests fue MG were inconclusive I don’t think I have it. Things have been ok for some time but about a year ago my eyes started going funny like a startled look with too much whites showing as if they eyes are bulging. I thought I might be imagining it but recently a relative has commented on it and told me to see a doctor. I have banged on and on about it at the opticians when I was in and out of there more times than I care to mention - swollen corneas, dry as a bone eyes, dermodex mites in eyelashes, swollen and puffy eyes all around the socket. I gave up in the end after a year of zero improvement using a mask and my questions about the possibility of being TED were completely ignored as if I had never ever mentioned it - absolutely hopeless I was annoyed to see someone here said they can even make referrals to an eye hospital. Gaslighted from the get go with all the hideous thyroid problems I have had and on it goes. Will have to muster up the energy to see my GP and discuss it with her. I’ve got to the stage of loosing the will to live where the medical profession is concerned. Plus I don’t want any MRI scans one was more than enough for two life times it frightened the living daylights out of me

[TSH110 in reply to PurpleNails]

Thanks for the link to that most interesting paper😉

[PurpleNails Administrator]

Unfortunately I think It would require an symptom as obvious as eye brows turning into rainbows colours for a doctors to take the possibility of TED seriously.

My eyebrows are a mix of mid brown & and where it’s regrown an almost colourless blonde. So does two tone count as Rainbow? They aren’t arched though which I realised what the article is about.

I showed my GP how the pupil on my right eye is approx 3mm higher compared to left he said -you have thyroid eye disease, you best tell your endocrinologist.

The endocrinologist said as I’m hyper from a nodule not Graves it’s unrelated see GP.

I pushed & they agreed to repeat the TSI antibody. As negative result - they concluded not thyroid related told to go back to GP.

GP didn’t understand and said you’re hyper it must be TED - see an optician.

The optician cancelled appointment as my pre appointment questionnaire was too concerning, see urgent eye clinic.

The urgent eye clinic said you need a sight test go back to optician.

Optician wrote a letter and GP submits to ophthalmology.

After cancelled appointments I eventually had a video appointment apparently in error. I was told it was just the lid drooping, hardly noticeable and nothing could be done cosmetically as I have…..TED.

I explained I was told I don’t and it wasn’t my lid it was the eye alignment. Oh I just glanced over the notes..Back on waitlist for face to face appointment, that was months ago.

[TSH110 in reply to PurpleNails]

What a shambles it’s as if they are deliberately trying to avoid diagnosing it, probably because it entitles us to more help with eye care so it’s a cost cutting exercise. The fact that it greatly affects eyesight and needs specialist care seems to be of no concern to them. If I had to give a descriptor of thyroid care in the U.K. I’d use USELESS