This document discusses Graves' disease and thyroid eye disease. It begins by explaining that Graves' disease is the most common cause of hyperthyroidism, which is an overactive thyroid caused by antibodies that stimulate excessive thyroid hormone production. It then describes the signs and symptoms of Graves' disease and thyroid eye disease. Testing options are outlined as well as treatment approaches like medication, radioactive iodine therapy, and surgery. Surgical options, risks, and recovery are discussed for both thyroid removal and orbital decompression surgery to treat eye swelling and bulging.

1. Graves’ and Thyroid Disease:
The Journey
CHASE LAY MD
ENT – OCULOPLASTICS –
SKULL BASE
Cupertino, CA

2. Grave’s
Disease
Surgical Considerations

3. 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

4. Grave’s Eye Disease - Inflammation

5. 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)

6. 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

7. 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

8. 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

9. Detecting Thyroid Nodules
Physical Exam
Ultrasound

10. 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

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

12. 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.

13. Surgical Treatment of
Eye Disease

14. Marty
Feldman

15. Grave’s Eye Disease - Inflammation

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

18. 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

21. Endoscopic Decompression
Extended or Advanced
Sinus Surgery

25. External Decompression

29. Risks of
Decompression
Surgeries
 CSF leak during endoscopic surgery
 Diplopia or Double Vision (often pre-
existing)
 Bleeding
 Infection
 Eyelid retraction or drooping

30. Droopy eyelid repaired

32. Thank you for your time