[isanora (OP)]

Hi, my name is Isabelle. I'm French and I live in England.

I've had Graves disease for the last 2 years. The English doctors advise me to go through treatment with radioactive iodine 131 but the French have found out that I have a slight thyroid eye disease in the left eye (exopthalmos). Apparently it wouldn't be a good idea to get the iodine 131 treatment.

Is there anyone who have Graves disease, a slight eye problem but still went through radioactivity?

Isabelle.

[Rokitansky]

This is not completly apropriate answer to your question, but here it is.

Exophthalmus is commonly seen in many people with hyperthyreosis. How it affects the choice of therapy, I don`t know.

Alternatively, hyperthyreosis can be treated chirurgicaly, but I`m not sure it is possible in Graves desease. I think it is.

If thyroid gland is completly removed (it doesn`t have to be) substitutional therapy with hormons is neccessary.

[bezoar]

The exopthalmus is caused by the thyroid/Grave's disease, and in fact, is one of the symptoms of Grave's disease. If you don't get the thyroid under control, the exophthalmus will get worse.  You can only stop it, not reverse it.  Surgery can fix the exopthalmus, but far better to fix the thyroid before the exopthalmus gets worse. And if you don't regulate the thyroid, the exophthalmus will recur.

[bezoar]

The exophthalmus is caused by the thyroid/Grave's disease, and in fact, is one of the symptoms of Grave's disease. If you don't get the thyroid under control, the exophthalmus will get worse.  You can only stop it, not reverse it.  Surgery can fix the exopthalmus, but far better to fix the thyroid before the exopthalmus gets worse. And if you don't regulate the thyroid, the exophthalmus will recur.

[Rokitansky]

quote:Originally posted by bezoar

The exophthalmus is caused by the thyroid/Grave's disease, and in fact, is one of the symptoms of Grave's disease. If you don't get the thyroid under control, the exophthalmus will get worse. You can only stop it, not reverse it.  Surgery can fix the exopthalmus, but far better to fix the thyroid before the exopthalmus gets worse. And if you don't regulate the thyroid, the exophthalmus will recur.

In GUYTON , it says that exophthalmus is greatly reduced after treating of hyperthyreosis !

[juniordoc]

just thought i'd give a quick rundown of the option for treatment of hyperthyroidism. they fall into two catagories
1 - partial reduction of thyroid hormone levels to normalise
2 - compleat removal of endogenous hormone with easy to control replacement.

options under catogary one include treatment with low to moderate doses of carbimazole, titrating to TSH levels or subtotal removal of the thyroid (not in graves)

catagory two includes hi dose carbimazole with replacement - chemical ablation.
thyroidectomy with replacement - (carries intrinsic risks of surg  and can dammage local nerves and parathyroid glands) od radioiodine ablation.

Most endocrinologist try a catagory one stratergy first then move to two but not always.

Radio iodine is very safe - more so than surgury. Carbimazole blocking tend to need gradually increasing doses of carbimazole and so you get two sets of side effects, and its not a good long term option.

As all have said. best control of thyroid eye disease, including eopthalmos, is achived through good thyroid control. But be warned that your exopththalmos may not regress even if you achive euthyroid status.

Mike

[bezoar]

That's what I always learned.  The exophthalmus was irreversible.  Is it or isn't it?

[Carabosse]

quote:Originally posted by Rokitansky

This is not completly apropriate answer to your question, but here it is.

Exophthalmus is commonly seen in many people with hyperthyreosis. How it affects the choice of therapy, I don`t know.

Alternatively, hyperthyreosis can be treated chirurgicaly, but I`m not sure it is possible in Graves desease. I think it is.

If thyroid gland is completly removed (it doesn`t have to be) substitutional therapy with hormons is neccessary.

[Carabosse]

Hi I had Graves disease years and had the treatment with the iodine.  All went well and never had problem since with the thyroid itself.  However I still had the exolphthalmia, a very bad case, with a lot a pressure one the eyes, to the point that one eyelid could not cover the eye and there was too much pressure on tha optic nerve. My doctor decided to operate, there are only 2 doctors in Canada that does this procedure. One is the ophthalmologist who operates on the eyena the oto rhino larynngo doctor who operates through your nose. They do a decompression on the eyes by removing bones, in other words they enlarge the cavity to replace the eyeballs. The operation lasted 6 hours and was a complete success. The exophthalmia gone.

[chris]

That's good news.

The exopthalamos associated with Graves disease is actually not due to the thyroid being overactive, it's actually caused by the proliferation of tissue behind the eye which pushes the eyeball forward in the orbit, giving the impression that the person has bulging eyes. The give away is that the edge of the iris (the coloured part of the eye) is visible all the way round. Normally it should be covered slightly by the upper or lower eyelid.

If the situation becomes too severe then 'congestive opthalmopathy' can develop whereby the pressure behind the eye compresses retinal veins, preventing blood draining from the eye properly which can threaten sight if not remedied speedily.

I'm glad that you've been sorted out, thanks for telling us about the process.

Chris

"I never forget a face, but in your case I'll make an exception"
 - Groucho Marx

[mehdisaleh]

Hi, I am a very new member and this subject is too interesting for me, as my mother suffers from Exophthalmia, Popeye and intra ocular pressure since 1990.
She is 59 years old.  
She does not appear in public because of her bulging eyes.

What Germaine Hebert (Carabosse) explained about her is too close to my mother case.
Yesterday after her last checkup the eye pressure was 25, (since it was 18 before) and I am so worry about her.

I want to ask for your help and any information related to this disease.
Best Clinics, Doctors and … around the world.

She was using TIMOLOL (I am not sure about spell as I am a programmer) drop, and LEVOTHYROXIN.
Since yesterday she uses ZANATAL.
Is there any other solution other than operation?

[suyel]

Hi, I have Graves disease with exopthalmus problem since 2000, i had an thyroid-operation (thyroid gland is almost completly removed)  but my thyroid antibody value is still really high and its one of the common reason for exopthalmus. Because of this high value i had also a radioactive iodine with cortison and it has no negative effects for exopthalmus (but with cortison therapy).
 Now my doctors advise me this decompression-operations on eyes but they say that the complications are really high and i really worry about it.
Thanks Carabosse for telling us about the process.

[shodashi]

Thyroid problems occur as a result of a person's attachment to his near and dear ones. Due to this, he feels hurt and gets angry when the latter donot do things according to his wishes/ego. Once a person becomes detached, he never feels hurt by their actions and has only love and affection for them and the thyroid problem also melts away. But for getting detached, a person should meditate on his self after realizing it.

Helping people to realize their souls/ spirits, meditate by teaching them meditation free of cost