Eye

Ask an Eye Doctor and Get an Answer ASAP

Ask a Doctor,
Get an Answer ASAP!

Eye

At what point would you make the recommendation that thyroid

Customer Question
surgery be a better option...
At what point would you make the recommendation that thyroid surgery be a better option for treatment of the Graves disease than I131 treatment? The endocrinologist is awaiting the recommendation of the neuro-ophthalmologist regarding Graves treatment. IV prednisone has made some improvement of the eye swelling and ocular movements. But mild symptoms return as it gets 5-6 days post IV steroid therapy. Today he received IV #3.
Submitted: 5 years ago.Category: Eye
Show More
Show Less
Ask Your Own Eye Question
Answered in 25 minutes by:
4/6/2012
Eye Doctor: Dr-Trace, Board Certified Ophthalmologist replied 5 years ago
Dr-Trace
Dr-Trace, Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 26
Experience: Board Certified in General Ophthalmology
Verified
Dr-Trace :

Hi I am Dr. Lewis and I would like to share a little information from an ophthalmologist's point of view regarding your question. The problem with eye swelling in Grave's disease is not caused by the thyroid. It is caused by antibodies produced by the immune system that attack the thyroid and also cross react and attack the muscles of the eye in the orbit. So it is difficult to answer your question regarding which procedure would be better for the thyroid. If there is less thyroid to attack by the antibodies, there will be less antibodies (possibly) but usually the muscle swelling in the orbit does not go down. Studies have shown that the extraocular muscles swell because of deposition of GAG proteins into the muscles (as a response to being attacked by antibodies) and this may be why your husband's symptoms are not getting better with steroids. If there is acute swelling in the muscles from attack by antibodies, this can be suppressed by IV steroids. But any GAG protein deposition in the muscles has already occurred and will not be helped by steroids.

Dr-Trace :

Surgical treatment or radiation treatment of the muscles of the orbit can debulk the swelling and this may be the option of choice for your husband. Ask the neuro-ophthalmologist.

Dr-Trace :

Hope this helps.

Dr-Trace :

Dr. T

Dr-Trace :

Hi - I am Dr. T and I am ready to answer any further questions you have.

Customer:

I understood that treatment with I131 could worsen the ocular effects from the already present thyroid antibodies. Did I misunderstand?

Dr-Trace :

No I don't think you misunderstood. I believe that destruction of the thyroid with I131 still leaves tissue that is susceptible to thyroid antibodies even though it is not viable thyroid tissue. The markers for the antibodies are still on the tissue. Therefore this would make sense since the antibodies would still circulate and attack the extraocular muscles.

Dr-Trace :

Removal surgically of thyroid tissue would remove the stimulus for the antibodies to attack and the attacks on the eye muscles would then also lessen.

Customer:

Can the thyroid antibodies continue to cause worsening of the TED even after treatment?

Dr-Trace :

The goal is to lessen the circulating antibodies as much as possible. So after surgical removal of lobes of the thyroid, there should be less circulating antibodies. But remember these same antibodies are still stimulated by the extraocular muscles themselves(cross reactivity) so they can still attack to a certain degree the extraocular muscles.

Customer:

Essentially we can treat the Graves and still potentially have continual, possibly worsening, TED? Any last suggestions?

Dr-Trace :

Yes. The thyroid eye disease treatment should be geared to realigning the muscles to minimize the diplopia (strabismus surgery) as well as treatments designed to debulk the swelling of the extraocular muscles. Radiation to the muscles is an option and I believe there are some other promising treatments but I am not an expert in the most current orbital treatments of thyroid eye disease. Again though, I think the focus should be on correcting the extraocular muscle problems.

Customer:

Thank you.

Dr-Trace
Dr-Trace, Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 26
Experience: Board Certified in General Ophthalmology
Verified
Dr-Trace and 87 other Eye Specialists are ready to help you
Ask your own question now
Ask Dr-Trace Your Own Question
Dr-Trace
Dr-Trace
Dr-Trace, Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 26
26 Satisfied Customers
Experience: Board Certified in General Ophthalmology

Dr-Trace is online now

A new question is answered every 9 seconds

How JustAnswer works:

  • Ask an ExpertExperts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional AnswerVia email, text message, or notification as you wait on our site. Ask follow up questions if you need to.
  • 100% Satisfaction GuaranteeRate the answer you receive.

JustAnswer in the News:

Ask-a-doc Web sites: If you've got a quick question, you can try to get an answer from sites that say they have various specialists on hand to give quick answers... Justanswer.com.
JustAnswer.com...has seen a spike since October in legal questions from readers about layoffs, unemployment and severance.
Web sites like justanswer.com/legal
...leave nothing to chance.
Traffic on JustAnswer rose 14 percent...and had nearly 400,000 page views in 30 days...inquiries related to stress, high blood pressure, drinking and heart pain jumped 33 percent.
Tory Johnson, GMA Workplace Contributor, discusses work-from-home jobs, such as JustAnswer in which verified Experts answer people’s questions.
I will tell you that...the things you have to go through to be an Expert are quite rigorous.

What Customers are Saying:

I feel so much better today, and upon further investigation believe that there is a chance that the responses I got saved me from a serious, even life threatening situation. I am very grateful to the experts who answered me.

Susan O.USA

Wonderful service, prompt, efficient, and accurate. Couldn't have asked for more. I cannot thank you enough for your help.

Mary C.Freshfield, Liverpool, UK

This expert is wonderful. They truly know what they are talking about, and they actually care about you. They really helped put my nerves at ease. Thank you so much!!!!

AlexLos Angeles, CA

Thank you for all your help. It is nice to know that this service is here for people like myself, who need answers fast and are not sure who to consult.

GPHesperia, CA

I couldn't be more satisfied! This is the site I will always come to when I need a second opinion.

JustinKernersville, NC

Just let me say that this encounter has been entirely professional and most helpful. I liked that I could ask additional questions and get answered in a very short turn around.

EstherWoodstock, NY

Thank you so much for taking your time and knowledge to support my concerns. Not only did you answer my questions, you even took it a step further with replying with more pertinent information I needed to know.

RobinElkton, Maryland

< Previous | Next >

Meet the Experts:

Dr. Dan B.

Dr. Dan B.

Board Certified Ophthalmologist

3,334 satisfied customers

Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology

Dr. Stan

Dr. Stan

Ophthalmologist

905 satisfied customers

Johns Hopkins Fellowship Trained, Certified and Licensed Medical Physician and Surgeon

Dr. Stevens

Dr. Stevens

Ophthalmologist

629 satisfied customers

Board Certified Ophthalmologist

Dr. Susan

Dr. Susan

Ophthalmologist

217 satisfied customers

Board Certified & Fellowship trained eye surgeon.

Dr. JP

Dr. JP

Ophthalmology, Oculoplastic Surgery

28 satisfied customers

Harvard Medical School, Massachussetts Eye and Ear

Dr-Trace

Dr-Trace

Board Certified Ophthalmologist

26 satisfied customers

Board Certified in General Ophthalmology

Dr. Daniel Jewelewicz

Dr. Daniel Jewelewicz

Board Certified Ophthalmologist

11 satisfied customers

Glaucoma Specialist, Associate Professor FAU, Teaching Faculty Bascom Palmer Eye Institute

< Previous | Next >

Related Eye Questions
I have strabismus, with my left eye stronger than my right.
I have strabismus, with my left eye stronger than my right. Lately I've been feeling a little light headed, but attributed it to seasonal allergies. Two days ago, when I went from a dimly-light hallwa… read more
Dr. Thomas, MD
Dr. Thomas, MD
2,227 satisfied customers
Ophthalmologist I have had twitching in my upper eyelids for
OphthalmologistI have had twitching in my upper eyelids for the last two weeks everyday. From my understanding, this condition may be Myokymia. I read it is caused by dry eyes, fatigue or lack of slee… read more
Dr. Arun Phophalia
Dr. Arun Phophalia
Consultant Surgeon and Sports Medicine
Post-Doctoral Degree
32,389 satisfied customers
I have been to 4 different doctors for double vision and eye
I have been to 4 different doctors for double vision and eye movement problems and they are all saying different things to me. I had a MRI and CT of brain done with orbits and all was normal. I had bl… read more
Gaurav Gupta
Gaurav Gupta
MD, CEO
Post-Doctoral Degree
22 satisfied customers
My mom went to an Ophthalmologist, he told her she has
My mom went to an Ophthalmologist, he told her she has cholesterol build-up behind one or both eyes, he told her if a blood clot would break free it could kill her if it went to her brain, stroke.. Tr… read more
wieyedoc
wieyedoc
Ophthalmologist & Retina Specialist
Doctoral Degree
518 satisfied customers
I just has Strabismus surgery June 2nd. today I noticed a
today I noticed a bubble wondering if it's just chemosis or something I should address at the hospital. How can I send a picture Dr? … read more
Dr. Longo
Dr. Longo
Optometrist
Doctor of Optometry
42 satisfied customers
I have had two very weird episodes the first time it
Hi... So I have had two very weird episodes the first time it happened I went to ER and they checked everything and did not find anything thought it could just be vertigo but the second time I was abl… read more
Dr. A.S. Desai
Dr. A.S. Desai
Board certified general ophthalmologist
Master\u0027s Degree
1,570 satisfied customers
I've been experiencing binocular horizontal diplopia in
I've been experiencing binocular horizontal diplopia in about 1,5 year now on distant gaze, worse when looking to the sides and especially to the sides and down. For about two months ago, I was examin… read more
wieyedoc
wieyedoc
Ophthalmologist & Retina Specialist
Doctoral Degree
518 satisfied customers
I have a specific question - i just saw an ophthalmologist,
i have a specific question - i just saw an ophthalmologist … read more
wieyedoc
wieyedoc
Ophthalmologist & Retina Specialist
Doctoral Degree
518 satisfied customers
I have 24 years. This is my finding ophthalmologists VOD:
I have 24 years. This is my finding ophthalmologists VOD: +0.25 = 1.00 -0,50X180 VOS + 0.25 = 1.0 -0,75X155 FOD: PNO neat, winding blood vessels of the eye especially around the macula FOS: PNO neat, … read more
wieyedoc
wieyedoc
Ophthalmologist & Retina Specialist
Doctoral Degree
518 satisfied customers
My brother (24) went to an ophthalmologist last weekend
Hello, my brother (24) went to an ophthalmologist last weekend because of a stye (or maybe it's a chalazion?) on his upper eyelid that doesn't want to go away. He was prescribed some kind of antibioti… read more
Dr. Arun Phophalia
Dr. Arun Phophalia
Consultant Surgeon and Sports Medicine
Post-Doctoral Degree
32,389 satisfied customers
I started to have some pain localized to my left orbit,
hi I started to have some pain localized to my left orbit, mostly lateral...I currently have a cold sore in my lip and not sure if pain is related to zygomatic nerve. I feel the most pain when blinkin… read more
wieyedoc
wieyedoc
Ophthalmologist & Retina Specialist
Doctoral Degree
518 satisfied customers
What might cause enlarged eye muscles, eyes checked 5 days
eyes checked 5 days ago. have had eye pain, sensation that the eye is larger than the other,blurry vision is affected eye … read more
Dr. Thomas, MD
Dr. Thomas, MD
2,227 satisfied customers
Strabismus Question: Is there an EFFECTIVE treatment for
Strabismus Question: Is there an EFFECTIVE treatment for strabismus, particularly exotropia? I've already had two unsuccessful surgeries, unsuccessful vision therapy, unsuccessful prism lenses, etc. I… read more
wieyedoc
wieyedoc
Ophthalmologist & Retina Specialist
Doctoral Degree
518 satisfied customers
I had strabismus surgery 2 and a half weeks ago how
I had strabismus surgery 2 and a half weeks ago how dangerous is it to smoke after that? … read more
Dr. Arun Phophalia
Dr. Arun Phophalia
Consultant Surgeon and Sports Medicine
Post-Doctoral Degree
32,389 satisfied customers
What to use to relax eye muscles, A month ago and I did get
A month ago and I did get prescription for of -1 on each eye … read more
Dr. Bob
Dr. Bob
Staff Physician
Doctoral Degree
2,215 satisfied customers
I have been suffering from eye muscle strain in both eyes
I have been suffering from eye muscle strain in both eyes for 3 weeks now. I have a history of MS, optic neuritis in right eye (5 years ago), however optometrist ruled out any optic nerve issues. I sh… read more
Gaurav Gupta
Gaurav Gupta
MD, CEO
Post-Doctoral Degree
22 satisfied customers
I moved to Denver in June. I need an ophthalmologist. I'm
I moved to Denver in June. I need an ophthalmologist. I'm having trouble seeing print in menu' adds on tv cannot see print.im a diebetic for forty years. It has never showed in my eyes, but something … read more
Dr. Mo
Dr. Mo
Urgent Care
MD
1,239 satisfied customers
For ophthalmologist ---- I am yrs old. No contact lens. I
For ophthalmologist ---- I am 69 yrs old. No contact lens. I have been having dry eyes. I went to my eye doc and he did an exhaustive exam. He said i had dry eyes (saw "sudsing" on the scan ) and pres… read more
wieyedoc
wieyedoc
Ophthalmologist & Retina Specialist
Doctoral Degree
518 satisfied customers
Disclaimer: Information in questions, answers, and other posts on this site ("Posts") comes from individual users, not JustAnswer; JustAnswer is not responsible for Posts. Posts are for general information, are not intended to substitute for informed professional advice (medical, legal, veterinary, financial, etc.), or to establish a professional-client relationship. The site and services are provided "as is" with no warranty or representations by JustAnswer regarding the qualifications of Experts. To see what credentials have been verified by a third-party service, please click on the "Verified" symbol in some Experts' profiles. JustAnswer is not intended or designed for EMERGENCY questions which should be directed immediately by telephone or in-person to qualified professionals.

Disclaimer: Information in questions, answers, and other posts on this site ("Posts") comes from individual users, not JustAnswer; JustAnswer is not responsible for Posts. Posts are for general information, are not intended to substitute for informed professional advice (medical, legal, veterinary, financial, etc.), or to establish a professional-client relationship. The site and services are provided "as is" with no warranty or representations by JustAnswer regarding the qualifications of Experts. To see what credentials have been verified by a third-party service, please click on the "Verified" symbol in some Experts' profiles. JustAnswer is not intended or designed for EMERGENCY questions which should be directed immediately by telephone or in-person to qualified professionals.

Show MoreShow Less

Ask Your Question

x