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Thyroid Diseases

Graves' Disease With Normal TSH

05/15/2006

Question:

I`m a female, 51 years old. For 5 years now I have problems with my eyes and sight. I went to a doctor and he said that it`s a problem with my eye muscle and he gave a medication. A year later I was diagnosed with Graves' disease. I did a blood test and I have high antibodies on TSH, TSH is normal, and my thyroid gland is functioning normal. How can have Graves'? And what is it? Is it some kind of auto-immune system disorder and how can it be treated?

Answer:

Graves' disease is a disorder in which the body's own immune system attacks the thyroid gland.  This attack stimulates the thyroid to make too much thyroid hormone.  In addition, some patients with Graves' disease also get an autoimmune attack against the tissues behind the eyes.  This can cause double vision, or can make one or both eyes bulge forward.  Usually patients get the thyroid disease alone or the thyroid disease plus the eye disease.  However, occasionally we see patients who have only the eye disease.  The thyroid disease may come later, or there may never be a thyroid problem. 

The treatments for Graves' Eye Disease can have a lot of side effects and don't always work very well.  Consequently, they are usually reserved for patients whose vision is threatened by the eye disease.  Your eye doctor and endocrinologist would be the best people with whom to discuss the potential risks and potential benefits of treatment for the eye disease.  The treatments include surgery, radiation therapy to the tissues behind the eyes, and high doses of steroids.

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Response by:

Thomas A Murphy, MD, FACP, FACE Thomas A Murphy, MD, FACP, FACE
Associate Professor of Medicine
School of Medicine
Case Western Reserve University