Graves’ and Thyroid Disease: The Journey

CHASE LAY MD

ENT – OCULOPLASTICS – SKULL BASE

Cupertino, CA

Grave’s Disease

Surgical Considerations

The Thyroid & Grave’s

Thyroid hormone is critical for regulating mood, weight, and mental and physical energy levels.

If the body makes too much thyroid hormone, the condition is called hyperthyroidism. (An underactive thyroid leads to hypothyroidism.)

Graves disease is the most common cause of hyperthyroidism.

Caused by an abnormal immune system response that causes the thyroid gland to produce too much thyroid hormones.

Body actually produces antibodies that activate thyroid hormone production

Grave’s Eye Disease - Inflammation

Signs & Symptoms

Anxiety Breast enlargement in men

(possible) Double vision Eyeballs that stick out

(exophthalmos) Eye irritation and tearing Frequent bowel movements Heat intolerance Increased appetite

Menstrual irregularities in women

Muscle weakness Nervousness Rapid or irregular heartbeat

(palpitations or arrhythmia) Restlessness and difficulty

sleeping Tremor Weight loss (rarely, weight

gain)

Testing for Graves Simple blood test

TSH, T3, T4

TSH receptor antibody; Thyroid stimulating immunoglobulin or “TSI”

Ultrasound of the neck if thyroid is enlarged or mass felt

Surgical Grave’s Disease Hyperthyroidism or progressing eye disease in patients

who can’t be treated with radioactive iodine therapy Rapidly worsening Thyroid Eye Disease Enlarged thyroid or Goiter causing difficulty breathing or

swallowing Women interested in becoming pregnant Nodule in a patient with Grave’s or a family history of

thyroid cancer Suspicious thyroid nodules

Change of malignancy in thyroid nodules is double in context of Graves

Thyroid nodules are common Can be found in 5% of the

general population Mostly benign Can be observed if there are

no risk factors

www.mythyroid.com

Detecting Thyroid Nodules

Physical Exam

Ultrasound

What is a suspicious thyroid nodule? A large nodule, >1cm Any nodule over 0.5cm in

size in a Grave’s patient A thyroid nodule in a

patient with1. A family history of

thyroid cancer2. A history of radiation

exposure3. Age younger than 20 4. Age older than 50

Surgery & Risks General anesthesia Small incision in the lower neck Hoarse voice Vocal cord weakness Visible incision Bleeding Low Calcium (Total

thyroidectomy)

After Surgery Small incision – Quick healing Typically stay in the hospital

overnight Back to work in a 2 to 6 days.

Complications with nerve weakness, post-operative bleeding, or calcium regulation may delay return to work.

Surgical Treatment of Eye Disease

Marty Feldman

Grave’s Eye Disease - Inflammation

Combination of compression of the optic nerve and inflammation of the nerve

Orbital Decompression &Fat Removal Performed both endoscopically and

externally Surgical treatment to save or

restore vision Should be thought of as a medical

necessity Additional corrective surgeries are

often required Typically outpatient procedures

Endoscopic Decompression

Extended or Advanced Sinus Surgery

External Decompression

Risks of Decompression Surgeries

CSF leak during endoscopic surgery Diplopia or Double Vision (often pre-

existing) Bleeding Infection Eyelid retraction or drooping

Droopy eyelid repaired

Thank you for your time