Whats Special About University Of Michigans Treatment Of Graves Disease
UM is one of the few places in the country that has a multidisciplinary group dedicated to the treatment of patients with Graves disease. UMs multidisciplinary group consists of endocrinologists, endocrine surgeons, ophthalmologists, nuclear medicine physicians, rheumatologists and psychiatric professionals. Our group sees Graves disease patients from around the country and is involved with one of the most well-known national organizations concentrating on helping patients and families coping with Graves disease and Graves eye disease. Our group routinely publishes papers with new research results on Graves disease.
The ophthalmologists in our group specialize in the treatment of Graves eye disease which can require complex management. Most ophthalmologists have little experience treating patients with Graves disease and Graves eye disease. For those patients with Graves eye disease, it is the severity of the eye disease which drives the selection of the type of treatment for hyperthyroidism if these two problems occur together.
While those patients with no Graves eye disease or only mild eye disease may be candidates for any of the three types of treatments for hyperthyroidism, those who have moderate to severe eye disease are often referred for surgical thyroidectomy as RAI has a higher chance of worsening the eye disease than surgery does.
What Is Graves Disease
Graves disease is an autoimmune disorder that can cause hyperthyroidism, or overactive thyroid. The thyroid is a small, butterfly-shaped gland in the front of your neck. Thyroid hormones control the way your body uses energy, so they affect nearly every organ in your body, even the way your heart beats.
With Graves disease, your immune system attacks your thyroid gland, causing it to make more thyroid hormones than your body needs. As a result, many of your bodys functions speed up.
Thyroid Disease And Glaucoma
Thyroid disease can be a cause of secondary glaucoma. Thyroid over or under activity can be associated with problems in and around the eyes. When it occurs, it is known as thyroid-associated ophthalmopathy.
Thyroid over or under activity can be associated with problems in and around the eyes. When it occurs, it is known as thyroid-associated ophthalmopathy. The socket in which the eyes are located can be affected by inflammation fluid and white blood cells can collect in the tissues behind and alongside the eyes causing swelling. This swelling pushes the eyes forwards so that they bulge, the blood vessels around the eyes open wide making them look red and angry and the eyelids pull back. All this makes it very hard to close the eyes properly. The front windows of the eyes cant be protected adequately and roughness or even ulcers can form. These can become infected, and may heal leaving scars.
Such pressures can lead to damage to the optic nerve fibres in precisely the same way as in any other glaucoma. This type of glaucoma is known as secondary, because we can identify a cause for the eye pressure elevation.
In extreme situations, glaucoma drainage surgery may be needed. This carries more risks than usual, and particular steps are taken by the surgeon to minimise complications and to maximise the chances of successful pressure control.
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Who Is More Likely To Have Graves Disease
Graves disease is more common in women and people older than age 30.2 You are more likely to develop the disease if you
- have a family history of Graves disease or Hashimotos disease
- have other autoimmune disorders, such as3,4
- vitiligo, which causes some parts of your skin to lose color
- autoimmune gastritis, which attacks the cells in your stomach lining
- type 1 diabetes, which occurs when your blood glucose, also called blood sugar, is too high
- rheumatoid arthritis, which affects your joints and sometimes other parts of your body
Symptoms Of Thyroid Problems
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Can Thyroid Issues Cause Eye Problems
The thyroid is a small butterfly-shaped gland located at the base of your neck. This endocrine gland is responsible for regulating your body’s energy use. It works with other glands and systems of the body to help determine what the body needs. For example, if you are cold or hot, this gland creates hormones that travel to the body’s cells to help regulate your body temperature. When you have issues with your thyroid, whether it is overactive or underactive , it can affect your body in different ways. As the thyroid gland regulates cellular metabolism in all the cells of your body, virtually every body system is affected when there is an issue with thyroid function.
How your thyroid and any problems it may have affects your vision is dependent on your diagnosis. Understanding your thyroid health and how it can affect your eyes and vision is the first step to ensuring your eye health remains intact while managing your thyroid condition.
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Who Develops Thyroid Eye Disease
Thyroid eye disease is a rare condition. Each year it affects about 16 women and 3 men in every 100,000 people. Most of these people also have a problem with an overactive thyroid gland and have an underlying autoimmune condition. Occasionally, thyroid eye disease occurs when the thyroid gland appears to be working normally. However, people with an apparently normal thyroid gland at the time of thyroid eye disease have usually had abnormal thyroid function in the past or they go on to develop abnormal thyroid function in the future.
Thyroid eye disease generally occurs in middle age. Some people carry genes which make it more likely that they will develop thyroid eye disease. It is also more likely to develop if you smoke, particularly if you are a heavy smoker.
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Thyroid Eye Disease Management
Thyroid eye disease is a self-limiting disease: if left untreated, the inflammation will gradually go by itself. However, the physical changes caused by the swelling may remain. This is because some of the tissues that have been stretched may not always return to their original form. The aim of treatment is mainly to limit inflammation and swelling occurring during the inflamed period and to protect the surface of the eye. There are also treatments for people whose tissues have not been able to return to their original form after the inflammation has settled.
Thyroid eye disease is managed by a specialist eye doctor and the underlying thyroid problem by your own doctor or by a a specialist in the hormone systems of the body .
Can Synthroid Thyroid Medication Cause Eye Problems
Eye problems are common in hyperthyroidism, a condition where your body has too much thyroid hormone. People can get Graves’ ophthalmopathy, also known as thyroid eye disease when the condition is unaddressed. But eye problems are not just restricted to people with hyperthyroidism. People with hypothyroidism can also experience eye issues. Eye issues associated with hypothyroidism may even be a side effect of common thyroid medications used to treat an underactive thyroid. Here’s what you should know if you struggle with eye problems and are treating your hypothyroidism with Synthroid.
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What Else Should I Know
We don’t know why people develop Graves’ disease. But with good medical help, kids and teens can be healthy and do all the things other kids and teens can do.
Graves’ eye disease can develop at any time in someone who has Graves’ disease. Smoke can make this eye disease much worse, so it’s very important to not smoke and to avoid secondhand smoke.
Women with Graves’ disease need to be very careful to keep their hormone levels in balance. Uncontrolled thyroid hormone levels in a pregnant woman can lead to problems during pregnancy and harm her baby.
What Is The Outlook For Thyroid Eye Disease
Thyroid eye disease is a temporary but drawn-out illness which fades away by itself. The inflamed period tends to last months to years , after which there is a healing response. For most people the condition will be mild, needing lubricants and regular assessments only. For those with more severe disease, the outlook depends on how early it is diagnosed and how intensive the treatment is. About 1 in 4 people with severe disease will end up with reduced eyesight.
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Is There Anything I Can Do
Yes. Here are a few tips:
- We know that one thing that makes this disease worse is smoking. If you smoke, see your GP about getting help to stop. Stopping smoking, even if you already have thyroid eye disease, will reduce the severity.
- Sleeping propped up will help reduce the puffiness around the eyes.
- You may find bright light uncomfortable. Sunglasses will help.
- If you are a driver and experience double vision, let the DVLA know. This is a legal requirement. Usually, they will contact your specialist eye doctor for a report. If the double vision is well controlled with prisms, you may be declared fit to drive. Until then you should not drive.
Thyroid Glands Relation To The Eye
Although Graves’ disease and Graves’ eye disease both stem from the immune systems attack on healthy tissue, one disease does not directly cause the other. Thats why treatment of the thyroid gland, while important, does not improve the eye disease. The two diseases run their separate courses and do not necessarily occur at the same time.
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Eye Symptoms And Treatment
Thyroid eye disease can affect many different parts of the eye and surrounding tissues. Inflamed lacrimal glands may cause wet eyes or dry eyes, and these can both happen in the same patient at different times. Lubrication with eyedrops or ointment can help to soothe this irritation. The abnormal immune reaction causes swelling in the tissues of the eyelids and orbit which can make the eyelids look puffy or as if the person has “baggy” eyelids. This can also create a sensation of pressure around the eyes. The swelling can be surgically altered to bring the lids back to a more normal shape.
The muscles in the eyelids tighten and pull the upper lid up and the lower lid down. This creates a startled look with too much of the whites of the eyes showing. This also can be surgically improved. The muscles which control movement of the eyes may be increased in size by the swelling. This can create problems with double vision and focusing. Prism glasses may be helpful, and this can also be improved by surgically moving the eye muscles.
The treatment options for vision-threatening problems in thyroid eye disease include corticosteroids or other anti-inflammatory medications, radiation and surgery. A combination of these may be necessary to protect vision. Most people with thyroid eye disease do not get corneal ulcers or optic neuropathy, but it is important to understand the symptoms so you know when to seek help.
How Does Thyroid Eye Disease Affect Mental Health
TED can cause eye pain, double vision, loss of vision, and changes to your appearance which may impact your quality of life. The impacts of TED can lead you to experience to depression, anxiety, loss of independence, and reduced self-confidence. You may have a decreased desire to socialize with others, have trouble with productivity at school or work, and stop doing activities you once enjoyed.
To help support your mental health as you deal with TED:
- Talk to your doctor: Talk to your doctor about any changes to your emotional well-being. Ask questions on how TED will affect your daily life and work.
- Seek support: Seek out support groups of others who are going through TED. The Graves Disease and Thyroid Foundation offers support groups for people with Graves disease, thyroid eye disease, and other thyroid conditions. These groups can help you learn about your condition, share your experience, and find support.
- Connect with others: Stay connected friends and family to keep you from feeling isolated.
- Take time to enjoy life: Take part in activities or hobbies that make you happy.
- Exercise: Exercise can help symptoms of depression or anxiety and make you feel better. Talk to your health care professional to determine what exercise routine may work best for you, especially if you have changes to your vision due to TED.
To learn more, check out the following resources:
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What Are The Complications Of Graves Disease
Untreated, Graves disease can cause serious health problems, including
- a rapid and irregular heartbeat that can lead to blood clots, stroke, heart failure, and other heart-related problems
- thinning bones, osteoporosis, and muscle problems
- problems with the menstrual cycle, fertility, and pregnancy
- eye discomfort and changes in vision
Why Aren’t There Any Ratings
There is no publicly available rating for this care provider for one of three reasons:
- Ophthalmology, Oculofacial Plastic Surgery and Ophthalmology Portland
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What Are Clinical Trials For Graves Disease
Clinical trialsand other types of clinical studiesare part of medical research and involve people like you. When you volunteer to take part in a clinical study, you help doctors and researchers learn more about disease and improve health care for people in the future.
Researchers are studying many aspects of Graves disease, including new medicines for treating Graves disease and GO.
Watch a video of NIDDK Director Dr. Griffin P. Rodgers explaining the importance of participating in clinical trials.
Symptoms Of Thyroid Eye Disease
Early symptoms of thyroid eye disease may include:
- Itching, dry eyes, and difficulty wearing contact lenses
- Excessively watery eyes
- Red or bloodshot eyes
- Swelling of the orbital tissues which causes the eye to be pushed forward referred to as exophthalmos, which can make people with thyroid eye disease appear to have a wide-eyed or bulging, protuberant stare.
- Pain when moving the eyes up, down, or sideways
- Light sensitivity
Thyroid eye disease can cause inflammation and swelling that may affect the eyes as well as the muscles and other tissues around the eyes. As the disease progresses, symptoms can include the following:
- Increased sensitivity to light
- Impaired vision
- Difficulty moving or closing the eyes
Thyroid eye disease is known to go through varying degrees of severity and can go into periods of remission. It often lasts six months to two years. When it has been inactive for a period of around a half a year, it’s less likely to recur.
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How Can I Take Care Of Myself
To relieve eye pain and other symptoms at home, you can:
- Apply cool compresses. Hold a wet washcloth to your eyes to moisten them and soothe soreness.
- Use lubricating eyedrops. Artificial tears can ease some of the dryness and scratchy feeling in your eyes. You might also use a lubricating gel or ointment before bed to keep your corneas from drying out if your eyes don’t fully close.
- Wear sunglasses. Thyroid eye disease can make your eyes more sensitive. Wearing sunglasses will protect them from ultraviolet light and wind.
- Sleep with your head raised. Keeping your head higher than your body can reduce swelling in your eyes.
- Cover your eyes. Use eye covers or tape your eyes closed to keep them from drying out if your eyelids don’t fully close.
How Is Thyroid Eye Disease Diagnosed
If you know that you have Graves’ disease, your doctor might recommend that you see an eye doctor. Theyâll check your eyes for bulging and enlarged muscles.
These are a few other tests for thyroid eye disease:
- Vision and color vision tests
- Visual field tests
- Tests of the optic nerve
You may also need one or more of these tests:
- CT. This is a powerful X-ray that takes detailed pictures of the inside of your eye.
- MRI. This uses powerful magnets and radio waves to make pictures of your eye muscles.
- Blood test. It measures levels of thyroid hormones or antibodies in your blood.
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