CHASE LAY MD
ENT – OCULOPLASTICS –
SKULL BASE
Cupertino, CA
Graves’ and Thyroid Disease:
The Journey
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)
Menstrual irregularities in
women

Muscle weakness

Nervousness

Rapid or irregular heartbeat
(palpitations or arrhythmia)

Restlessness and difficulty
sleeping

Double vision

Eyeballs that stick out
(exophthalmos)

Eye irritation and tearing

Frequent bowel movements

Heat intolerance

Tremor

Increased appetite

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 preexisting)

Bleeding

Infection

Eyelid retraction or drooping
Droopy eyelid repaired
Thank you for your time