Graves Eye Disease [transcript][audio]

Guest: Dr. Tushar Patel

Presenter: Neal Howard

Guests Bio: Dr. Tushar Patel is double board certified in plastic surgery and general surgery by the American Board of Plastic Surgery and the American Board of Surgery and he is a Fellow of the American College of Surgeons (FACS). He is a specialist in reconstruction after cancer surgery and traumatic injury. Dr. Patel received his undergraduate degree from Rutgers University, graduating with honors. He earned his medical degree from the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, from which he graduated in the top of his class.

Segment overview: Dr. Tushar Patel, MD, FACS from The Institute for Advanced Reconstruction at The Plastic Surgery Center talks about Graves’ ophthalmopathy or Graves’ eye disease.


Neal Howard: Welcome to the program, I’m your host Neal Howard. So glad that you could join us today on Health Professional Radio. We have a guest in studio today, Dr. Tushar Patel. He’s from the Institute of Advanced Reconstruction at the Plastic Surgery Center, and he’s joining us here today on Health Professional Radio to talk about Graves Eye Disease. This condition is characterized by bulging eyes and I will let Dr. Patel give us some more insights. Welcome to Health Professional Radio, Dr. Patel. How are you?

Dr. Tushar Patel: I’m good. How are you? Thank you for having me.

N: Good. Give our listeners just a little bit of background about yourself.

P: So I’m a plastic and reconstructive surgeon. I’m both certified in plastic and reconstructive surgery. I’ve been in practice about 11 years, I trained at the University of Texas in Houston. And one of my sub specialties within plastic and reconstructive surgery is doing orbital decompression for graves ophthalmopathy.

N: Graves ophthalmopathy. I said it was characterized by bulging eyes. But this is not an overactive thyroid related condition. Is that correct?

P: No. This Graves disease is the more general medical term and Graves disease is a hyperactive thyroid. That thyroid just works too aggressively it’s almost like it is on amphetamines. And what happens is one of the manifestations of patients who have Graves disease is they can have this ophthalmopathy which is just a disease specific to the eyeball itself.

N: Okay. Most people would recognize the term hyperactive thyroid in relation to Graves eye disease.

P: Right. There is a sub set. So there’s a lot of different reasons to have a hyperactive thyroid and one of the reasons. But most common reason actually is Graves disease and it’s an autoimmune disease so there are certain markers that can be diagnosed to confirm that a patient has that disease. There’s no cure for Graves disease but it can be controlled.

N: You mentioned markers to identify patients that are suffering from Graves. Are these genetic markers that can be identifiable early on in life as opposed to waiting for symptoms?

P: No. There are no genetic markers that I know as of now, like genes and things like that. But if someone is suspected to have Graves disease with the symptoms of hyperactive thyroid, then there’s some blood test that can be done to those blood test that that disease can be confirmed.

N: Talk about a typical patient. I understand that you have treated a woman for Graves disease recently. Talk about Mary Ellen Pierce if you would.

P: So Mary Ellen Pierce, she’s probably middle aged in her late 50s or maybe early 60s. She was diagnosed with Graves disease a couple of years ago and she’s presented to her process of after the diagnosis of Graves disease, to have a discomfort in her eyes. It started out with just eyes that really dry, then they’ve been a little scratchy, maybe the white part of the eye in the morning was a little bit more red in color from the dryness. But then as the disease progressed, the eyes started to get more and more irritated. And what happened with Mary Ellen is that in Graves disease when the eyes are affected, the eyes have muscles around them and those muscles are involved in moving the eyeball up and down, side-to-side so you can look where you want to look. These muscles get infiltrated by fatty tissue and the disease is responsible for doing this and then you get swelling around the eye. And what happens after that is the eyeball, because it’s in the face that has exact volumes so if you make that muscle bigger or it gets puffy and enlarges, it pushes the eyeball out of the socket. And when that happens you get bulging of the eyes that we typically see. And that’s what happened to Mary Ellen. Subsequently, Mary Ellen had surgery for the Graves disease, there’s a couple of ways to treat Graves disease. One is to remove the thyroid gland, so then that takes care of the disease or you have to take radioactive iodine. What that does is suppresses thyroids so it does not allow the thyroid to work. But unfortunately, when you do that whatever happened with the eyes stays that way or it can progress still for a short period of time. And she was at the point where even though the Graves is not in her system anymore, the eyes were still bulging and irritating and symptomatic.

N: Is this something that affects men and women equally? Or is there as far as young adults, people are up in age? Is this something that not discriminate or are there some I guess for lack of a better term, some rules that we can go by when dealing with Graves?

P: It does affect women more than men. There’s probably like 2 1/2 to 3 1/2 times more incidence in women than in men. It’s usually middle age to late middle age, so most patients that we see are probably in 40s or in 50s. Although my youngest patients that I have had with the ophthalmopathy of Graves was in their early 20s.

N: Briefly talk about the success ratio when it comes to nonsurgical treatments like you mentioned earlier, radiation, radiated iodine and the surgeries that you perform within your area of expertise.

P: So your question is time-line or the sequence?

N: Results. Results as far as success with nonsurgical treatments as opposed to surgical treatments when dealing with Graves.

P: So basically what we see is, let’s say we take a hundred patients that are diagnosed with Graves disease. Only about 20% of them will have eye findings, okay, where the eyes are bulging. The other 80% won’t have any symptoms or manifestations of having issues with the eyes. So then it’s just a thyroid issue and they can be treated that way. Of those 20 patients, after they have their iodine and/or thyroid is removed then probably I would say another 40-50% may be okay and not need anything done for the eyes themselves. Unless it progresses which is not common once you’ve had the thyroid taken care of. That remaining group, the 10% is doesn’t need some sort of surgical intervention in order to improve the look of the bulging eyes and improve them for the symptoms.

N: We briefly touched on cancer, thyroid conditions causing Graves. What about just trauma? Trauma to the eye, a blow, something getting in the eyes, something along the nature that something that is not cancer or something biological some trauma. Is the treatment going to vary greatly based on the nature?

P: It does. That’s a great question because you know the term bulging eye is a very generic term. But the majority of patients that have bulging eyes is due to this thyroid, the hyperactivity dysfunction Graves disease. But you can get it from other causes, you mentioned cancer. So you can have cancers that are present behind the eyeball or in the socket there that can push to eyeball out. So usually those patients are one … and usually get confirming test like an MRI or CAT Scan to rule out any masses or cancers that may be present. As far as trauma is concerned, you get punched in the eye or you fall on something, again those usually are one sided or the other. And those are acute injuries, so you’re going to see stigmata of having been bruised, black and blue, a lot of swelling, vision changes and in those circumstances that is not an infiltration of the fat into the muscles but just you may have some blood that’s behind of the eyeball that pushes to that so we just have to remove the blood, take care of the issue and that should get better pretty quickly.

N: Now where can we go, the listeners and get some more information about the Institute for Advanced Reconstruction at the Plastic Surgery Center and also about your area of expertise – Orbital Decompression Surgery?

P: So there’s a couple of places, I want to make mention I will be actually and this will be a part of our website as well, I’m going to be presenting a paper at the International Society for Endocrinology at British Endocrinology Society in the November as well. But if you go to our website there is a link that will lead you to all the sub-specialty work that our practice does and then you’ll see a link for Graves disease orbital decompression for Graves Ophthalmopathy and that has a bunch of pages referring to everything that we talked about today and contact and where to find us and how to email us and all those things.

N: Dr. Tushar Patel, it’s been a pleasure and I hope you’ll return and speak with us some more in the future.

P: Thank you.

N: You’ve been listening to Health Professional Radio. I’m your host Neal Howard in studio with Dr. Tushar Patel. Transcripts and audio of this program are available at and also at You can subscribe to this podcast on iTunes, listen in and download it at SoundCloud. And be sure to visit our Affiliate page at

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