Graves Disease

proptosisGraves disease of the eyes refers to the change in facial appearance in patients who suffer from an over or under active thyroid gland. This occurs more commonly in women, and is worse in smokers. It is referred to by many names, which creates confusion to patients. Thes names include Graves Ophthalmopathy, Graves Orbitopathy, Thyroid Eye Disease, Thyroid related immune orbitopathy, and Thyroid associated orbitopathy (How confusing!). All names refer to the same immune disease which affects both the thyroid gland and the face.

What do patients notice?

Often, patients dont notice anything until it is too late. Early on, subtle symptoms may occur including puffyness of eyelids, red eyes, and typically, watery eyes. Patients are often misdiagnosed as suffering allergies, when none exist!

Over time, the complaint becomes dominated by puffyness and wateryness. Bulging of the eyes is often noted by a friend, rather than the patients. Typically, patients avoid having their photograph taken. If the disease continues to progress, and is left untreated, it it can lead to glaucoma, blindness or even both.

Why does Graves disease occur?

Graves disease is actually an IMMUNE disease, which involves, the thyroid gland, the skin and the tissues of the upper face surrounding the eye. It does NOT directly involved the eyeball! The exact immune reason is not understood by modern science. However, managment of the disease requires measuring the elevated antibodies associated with the disease, and monitoring the fall in these antibody levels in response to treatment. Graves disease is most common in patients between 40 to 50 years old, with a sex predisposition towards females more than males.

When should I have treatment, and what type?

Investigations should be undertaken as soon as the disease is suspected, to confirm the diagnosis. Confirmation of the disease often occurs after appropriate blood testing. Once the disease has been confirmed, the thyroid homone treatment is usually commenced by an Endocrinologist. Orbital and plastics review is undertaken if there is any involvement of the eyes or face.

The treatment of thyroid disease affecting the orbits is complex, and involves close conjoint care with the GP and Endocrinologist. Sometimes, low dose orbital radiotherapy is required to reduce the inflammation, and at other times, plastic surgery is required to remove the bulging appearance of the eyes.

What types of plastic surgery are available to correct Graves disease?

There are many different types of surgical procedures available. The first is orbital decompression, to place the eyes back in their sockets. A few months after this is done, eyelid plastic surgery will be offered to ensure the eyelids are in the correct place. Finally, any excess or baggy skin can be removed...this is called "blepharoplasty".

Dr Maloof specialises in advanced plastic surgery for the correction of thyroid disease of the eye, and performs this using advanced computerised surgical navigation instrumentation.



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