What is Thyroid Disease?

Autoimmune thyroid disorders cause either an overactive thyroid gland (hyperthyroidism), an underactive thyroid gland (hypothyroidism), or no effect on the thyroid gland at all. Hyperthyroidism is when the thyroid gland makes too much thyroid hormone. Grave’s Disease is the most common type of autoimmune hyperthyroidism. Hypothyroidism is when the thyroid gland does not make enough thyroid hormone. Hashimoto’s Thyroiditis is the most common type of autoimmune hypothyroidism. Of all the autoimmune thyroid disorders, Grave’s Disease is the most common.

Graves’ disease most commonly affects women over the age of twenty and women are five to six times more likely than men to get the disease. Smokers are also much more likely to develop the disease and when they do, they tend to have more severe and longer lasting symptoms. In the U.S. approximately one million people are diagnosed with thyroid disease each year.

What Causes Thyroid Disease?

Thyroid disease can affect the thyroid gland, eyes, and skin. Unfortunately, the cause of Graves’ disease is unknown; however, current research suggests that a defect in the immune system may be the underlying cause of the disorder. Normally, the immune system uses antibodies to help protect the body against viruses, bacteria, and foreign substances. In Graves’ disease the immune system mistakenly attacks the thyroid gland, eyes, and skin of the lower legs causing the disease’s symptoms.

How is Thyroid Disease Treated?

Thyroid disease is treated by an endocrinologist, a medical specialist in glandular and hormonal disorders

The physician may suggest one of three treatments for hyperthyroidism: Anti-thyroid medications that block the action of the thyroid hormones, radioactive iodine, a solution that collects in the thyroid gland destroying large amounts of thyroid tissue, or surgery to remove most of the thyroid gland.

Following treatment, the thyroid often becomes underactive (hypothyroidism). This causes symptoms to subside. When the thyroid becomes underactive, the physician prescribes a synthetic thyroid hormone to achieve an appropriate balance.

What is Thyroid Eye Disease?

When Graves’ disease affects the eyes, it is called thyroid ophthalmopathy, thyroid orbitopathy or thyroid eye disease. Eyes may bulge or appear red and swollen. The space between the eyelids may widen. Excess tearing and discomfort may occur in one or both eyes. Patients may experience sensitivity to light, blurring, double vision, inflammation, decreased movement of the eyes, or loss of vision.

In thyroid eye disease the eyeball protrudes beyond its protective orbit (the surrounding bone and soft tissue around the eye). When this happens the tissues and muscles swell causing the eyeball to move forward in the orbit. The front surface of the eye can dry out. Eye symptoms and hyperthyroidism symptoms typically appear within eighteen months of each other.

What is the treatment of thyroid eye disease?

Thyroid Eye Disease is treated based on the severity of the disease and the symptoms. Sometimes combinations of surgical procedures are needed. Recommendations may include: topical gels and drops, medications or radiation to shrink the swollen tissues around the eyes, orbital decompression surgery, eyelid surgery, or eye muscle re-alignment surgery.

What it orbital decompression surgery?

In orbital decompression surgery the bone between the eye and the sinuses (air spaces next to the orbit) is removed. A successful procedure improves vision and provides room for the optic nerve (the nerve between the eye and the brain) and the eye. Most decompression surgery is undertaken to relieve pressure on the optic nerve and prevent possible blindness. However in cases of severe bulging of the eyes or increased pressure inside the eyes, an orbital decompression will allow the eyes to slip back into the orbit’s protection, decreasing the bulging appearance of the eyes, and lowering the pressure inside the eyes.

As an oculofacial plastic surgeon, Dr. Lissauer is trained in orbital reconstruction and surgical management of Thyroid Eye Disease. Orbital decompression is performed on one eye at a time as an outpatient procedure. The procedure requires general anesthesia and usually takes one to two hours depending on if other simultaneous procedures are performed. Recovery usually requires one to two weeks for the initial swelling and bruising to subside and then four to six weeks for the eye to settle into the desired position.

What is eyelid surgery for thyroid eye disease?

Thyroid Eye Disease can cause the upper and lower eyelids to retract or open more widely, giving a widened staring appearance. The front surface of the eye becomes exposed and dried out, with discomfort, redness, and excessive tearing. Surgically repositioning the eyelids can significantly reduce the irritation and improve the cosmetic appearance. The protruding fat in the upper and lower eyelids can simultaneously be removed if the patient desires to also improve the bulging appearance.

Eye Muscle Surgery for Thyroid Eye Disease

Double vision (seeing two images simultaneously) can occur in Thyroid Eye Disease because the eyes are out of alignment. Misalignment is caused by one or more eye muscles thickening from swelling and scar tissue. The goal of eye muscle surgery is to achieve single vision when looking straight ahead and when reading. More than one operation is sometimes required. If orbital decompression, eyelid and eye muscle surgery are required, the orbital decompression surgery followed by the eye muscle surgery, and then the eyelid surgery should be performed in that order.

Although Thyroid Eye Disease may affect vision, comfort, or appearance, many of these problems can be treated successfully, either medically or surgically. A Thorough discussion and in-depth consultation with Dr. Lissauer will help determine an appropriate treatment plan.

If you would like to schedule a consultation regarding Thyroid Eye Disease please contact our New York office at: 212-717-2150 for an appointment.