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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7364
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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My ophthalmologist says that my exophthlamia is due to my thyroid

Resolved Question:

My ophthalmologist says that my exophthlamia is due to my thyroid problem. One of my endocrinologists believes I have Hashimoto, and another doesn't. They both think I'm hypothyroid. I've had symptoms for years like fatigue and general slow down. My left eye is however protruding now more frequently, daily. My ophthalmologist says that the muscle behind the eye is being attacked by the hypothyroid-condition and there is nothing he can do but to offer check ups every 6 months. CAT scans of the eyes revealed nothing. Both endocrinologists don't think the eye condition is related to the thyroid as I am not hyperthyroid. I am still not taking any medication for hypo as one of my endocrynogists and I are just watching the TSH T4 and T3 trends and the trend is showing that I may flip into hyper. Whenever my eye is protruded my mental abilities are somewhat foggy or it feels like I had a glass of wine. This was kind of fun for the first few years when this all started, around 2007 but now it's just kind of debilitating and I'm afraid it's getting worse. Ednocrynologists say that if the eye protrusion was related to the thyroid it would be a constant, long lasting protrusion measured in months or years, and not in days. My eye (initially left but now also the right) goes back into the socket and looks perfect in the morning when I'm rested but as I progress through the day it may pop out and looks like an eye of a person having graves disease, which I don't have. I'm not sure if eye popping causes the fatigue or if the fatigue causes the eye popping. Anyhow I've been tested for every allergy known to medicine and all came negative. I stopped eating all the wheat and everything made of wheat for the 3d week now and it's definitely eliminated my brain attacks related to MSG and similar neuro-toxins hidden in foods like preservatives in breads which I suspect over the years led to my immune system failure possibly leading to Hashimoto. My both parents have a hypothyroid condition. My vision is perfect, I had it checked few months ago.

Does anyone know anything about this odd eye popping phenomena? What could be causing it and what's the worse that this may develop into (whether it's caused by thyroid or not)
Submitted: 1 year ago.
Category: Eye
Expert:  Dr. Rick replied 1 year ago.

Dr. Rick :

Hi. I'm online and happy to answer your question today.

Dr. Rick :

You can have thyroid eye disease even with a completely normal thyroid function tests, so even though you test normal that really does not rule out Graves Disease.

Dr. Rick :

MRI is also a better way to evaluate the conditions of the eye muscles then CT scan. Also, a test in the ophthalmologists office, called a hertel exophthalmometer, is very useful in evaluating for this issue.

Dr. Rick :

On the other hand, your endocrinologist is right....in the vast majority of patients exophthalmia from thyroid eye issues does not significantly change from moment to moment.

Dr. Rick :

Have you had an ophthalmologist examine you when your eyes were "normal" and when they were "popping out and being fatigued"? If not, this would be something important to do.

Dr. Rick :

The symptoms you have posted are very unusual and interesting. Perhaps it might be time for you to seek another opinion at a Large University Medical Center.

Dr. Rick :

At an institution like that you could be evaluated and treated by a team of sub-specialists who are at the cutting edge of their respective fields. The best thing about these large teaching hospitals is that consultations are available with Professors and leaders in their field by just walking a few steps down the hall.


 


The Mayo Clinic in Rochester, Minnesota is an excellent example of just such a place as this. That being said there are many excellent teaching hospitals all across the country and I am sure that there is one near you.


 


If you could tell me what large city you live near and how far it would be possible for you to travel in seeking treatment I would be happy to give you some names. Of course, you could also ask friends and associates or check the internet yourself. Let me know what you would like to do.


 

Dr. Rick :

Is there anything else you would like to discuss at this point or have all your questions been answered to your satisfaction?


 


I hope this information was helpful for you. But I do work for tips so I want to make sure you are happy with me before rating me. If you have another question on this or a related issue feel free to fire away. And please let me know if the rating system gives you any troubles.

Thanks in advance,

Dr. Rick MD FACS

Expert:  Dr. Rick replied 1 year ago.
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Customer: replied 1 year ago.

Dear Dr. Rick


 


thank you so much for the detailed reply!


 


I live in NYC (10029 zip) and work in NJ (07059) and I'd gladly follow up with your idea to get examined by a university professor at a teaching facility. Would you please suggest teaching hospitals in my areas?


 


Also thank you for reinforcing the idea of seeing an ophthalmologist at the time when the eye is popped out, that has also been brought out before but it's hard to time with scheduling appointment systems most vision centers have given the precarious eye popping "mood". Do you think it is possible to "strike a deal" with my eye-doc (or any eye doc for that matter) where I would just show up when it's popped and he'd drop everything on his schedule for my visit? I guess I'd need one visit just to arrange the unscheduled visit if they'd ever agree to that - please help if you have better ideas.


 


 


Is it a good idea to start using perforating glasses in order to straighten the eye muscles?


 


And the last question: Is it better for eyes to look at the lowest brightness monitor for the looooong hours, vs brighter monitor screen settings?


 


Thanks


 

Expert:  Dr. Rick replied 1 year ago.
Iv,

Yes. It should be possible for you to arrange to just show up at the office so the ophthalmologist can examine you during the acute phase of your issue. This should not cause any issues with the doctors schedule.

As a matter of fact, I trained in NYC and would highly recommend New York Eye and Ear or Manhattan Eye and Ear Hospital as teaching institutions.

Perforating glasses (pinhole) are not indicated in your condition. Do not waste money on them.

Set the screen brightness at whatever level you are comfortable at. The monitor brightness, even set on max, will not damage your eyes in anyway.

It's safe for you to press the positive feedback button now if you so desire. And, never fear, even after you press that button I don't go up in a puff of smoke -- I'll still be right here to continue helping you, but, as I do work for tips, I want to make sure you are happy before rating me.
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7364
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
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