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 with

1. A family history of thyroid cancer

2. A history of radiation exposure

3. 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