Oculoplastic surgeon Dr. Don Kikkawa explains that Grave’s disease is thought to be caused by the immune system, rather than an overactive thyroid.
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Understanding Grave’s Disease Dr. Travis Stork: Joining us is Dr. Don Kikkawa from UCSD Shiley Eye Center who performed Sibylle’s operation to fix her protruding eyes. Thank you sir for being here. Dr. Don Kikkawa: Thank you for having me. Dr. Drew Ordon: Welcome. Dr. Travis Stork: So other than Sibylle, who is the right candidate for this type of surgery? Dr. Don Kikkawa: Well, years ago when this operation was described it was considered very risky as I'm sure you can understand that. And many patients were told, “Don’t do anything. Live with the condition.” But in certain cases, patients that are severely disfigured, they don’t look like themselves. They have shunned their activity within their social circle because they can’t go out. Another good reason would be the pain and pressure that people feel from the eyes bulging out. Dr. Drew Ordon: So what is to for it’s not -- it’s cosmetic obviously with that bulging look but also there are symptoms with all that build-up of pressure of extra tissue in fact, the globe. Dr. Don Kikkawa: Right, the tissue build up here occurs in the muscles and the soft tissue pushes the eye out. So yes, that does cause discomfort. Dr. Travis Stork: You know people need to know this at home. Your eye bulging is just one of the symptoms of Grave’s disease. Other symptoms you might have, anxiety, irritability, difficult time sleeping, a lot of times an irregular and rapid heartbeat as well as increase perspiration and then the protruding eyes that we’re talking about. Dr. Drew Ordon: Right, we don’t know exactly why but that extra thyroid hormone circulating in the body has a direct effect on the eyes. And I want you to check this out exactly what’s going on with the thyroid gland, the so-called master gland, is producing too much thyroid hormone. And it has a direct effect as you said on the soft tissue structures in and around the globe that causes the muscle soft tissue structures to enlarge and in turn that bulging look. Dr. Don Kikkawa: You know the actual cause will start to be in the immune system nowadays. And it’s kind of called the thyroid eye disease but it’s somewhat of a misnomer. The immune system independently attacks the thyroid gland and the eyes and causes the eyes to bulge. Dr. Travis Stork: We saw in that model there, there will be really eye -- Dr. Don Kikkawa: It bulges out and some people have the thyroid gland remove but yet the eyes can still have problems. So we know it’s immune system that’s really the underlying problem. Dr. Travis Stork: So Sibylle had this surgery with Dr. Kikkawa. Just five weeks ago she’s already had some improvement in her eyes. Everyone is excited to see Sibylle’s new results? Dr. Drew Ordon: Yes. Dr. Travis Stork: Alright now Sibylle, come on out of here. Hello. Welcome. Dr. Drew Ordon: Well, you're welcome. You know this guy too. Sibylle: Hi. Dr. Drew Ordon: Nice work, have a seat right here. Dr. Travis Stork: So I want everyone once again to look at you before and let’s compare it now after the surgery. Dr. Drew Ordon: Big difference and how are you feeling? Sibylle: I feel great. It’s just wonderful. I don’t have any more pressure behind my eyes. I don’t feel I have to use efforts to keep my eyes close. I can just relax. What’s also very nice is I don’t have kids pointing at me and telling me I have you know-- Dr. Drew Ordon: Bug eyes. Sibylle: Yes. Dr. Travis Stork: Everyone talks about the smile but the eyes are the other thing that you look at the first time when you greet someone and if I were to look at you right now I would never know that you had suffered with Grave’s disease. I do want people at home to know that there are certain situations where you need to pay attention. Family history of Grave’s disease, women are seven times more likely to get this disease if you smoke depending upon your age. That certainly can be a risk factor so you’ve got to pay attention to those potential risk factor