Thyroid Eye Disease Clinic in Minnesota Overview

At Mayo Clinic, people with Graves' disease and eye symptoms receive expert care from a multidisciplinary team of doctors and surgeons in the Thyroid Eye Disease Clinic. Thyroid eye disease (Graves' ophthalmopathy) can cause vision loss, eye pain, bulging eyes and eyelid swelling.

During your visit, your doctors talk with you about your concerns and assess your condition. Then together you'll develop a treatment plan that addresses your goals, which may be preserving your vision, improving eye symptoms and restoring the appearance of your eyes. Your thyroid function will also be evaluated and treated. Surgery may be scheduled, or your doctors may discuss medical options with you.

A team approach

At the Thyroid Eye Disease Clinic, doctors who specialize in nose and sinus problems (rhinology), the eyes and eye socket (ophthalmology), the endocrine system (endocrinology), and others work together so that you get exactly the care you need. The team's seamless collaborative approach offers customized and efficient treatment.

When you arrive at the clinic in the morning, you'll meet with each specialist and complete any needed blood draws, vision assessments and imaging scans. The doctors then review your photographs, scans and lab results at a noon conference and develop a common plan of action. In the afternoon, you'll meet with your endocrinologist and ophthalmologist to discuss the proposed plan and any questions you may have. Your best treatment option might be an anti-inflammatory medication or it might be surgery.

You'll also receive a follow-up care plan that you can take to your home doctor. Because smoking worsens thyroid eye disease, this plan may include a referral to Mayo Clinic's Nicotine Dependence Center.

More than 1,600 people with Graves' disease are treated at Mayo Clinic each year.

Virtual visits

Virtual visits are a useful option, especially for people who are considering traveling to Mayo Clinic from a long distance. These discussions between you and a Mayo Clinic thyroid eye disease specialist can be done over the phone or by videoconference. You'll be asked to submit photographs, lab results and CT images before the appointment.

Mayo Clinic Thyroid Eye Disease Clinic

Elizabeth Bradley, M.D.: I'm Dr. Elizabeth Bradley. I'm one of the orbital surgeons at Mayo's Thyroid Eye Disease Clinic. Mayo has really been at the forefront of scientific investigation in thyroid eye disease and thyroid disease in general since the time of the Mayo brothers. Some of the landmark studies in thyroid disease, natural history and epidemiology were performed here at Mayo Clinic. Those were followed by early studies looking rigorously at the effect of orbital radiation for thyroid disease. And up to the present day, we're involved in looking at some of the newer therapeutic agents.

Lily Wagner, M.D.: During their visit in the thyroid disease clinic, patients are evaluated by an ocular plastic and orbital specialist, a strabismus surgeon, an endocrinologists and an ENT surgeon. The goal of the visit is for patients to gain an excellent understanding of their disease process; to get an idea what their course may be over the next months or even years; and to learn about different treatment options that are available to them.

Marius Stan, M.D.: Hello, I'm Marius Stan. I'm an endocrinologist here at Mayo Clinic. Many of these patients, as you might know, have an overactive thyroid condition called Graves disease. But that is not always the case. Some patients have normal thyroid levels or even low thyroid levels. Normalizing thyroid hormone levels is very important for the overall health. And I'm thinking hard bones and other organs. But it is also important for the eye disease itself. In addition, some of the medications that we use for thyroid disease can affect other endocrine functions like glucose control. And thus these medications are best managed through this multidisciplinary clinic.

Janalee Stokken, M.D.: If patients develop bulging of the eyes due to swelling of the muscles and fat and the eye socket, they may need orbital decompression surgery. We can achieve removal of the orbital wall medially and the floor with endoscopic sinus surgery through the nose and sinuses. This minimally invasive approach avoids additional external incisions and bruising and can be done alone or in combination with the decompression of the lateral orbital wall through a small eyelid incision. The use of intra-operative navigation can make this surgery even more affected.

Erick Bothun, M.D.: My name is Erick Bothun. I'm a strabismus surgeon at the Mayo Clinic. Strabismus means the eyes are not aligned. Swelling of eye muscles from thyroid disease can lead to double vision or diplopia. In many patients with thyroid disease, double vision and loss of depth perception greatly affects visual functioning and activities of daily living such as driving. If double vision does not resolve once the inflammation of the muscles subsides, patients may be candidates for eye muscles surgery to restore the alignment of the eyes and improve or eliminate double vision.

Andrea Tooley, M.D.: I'm Andrea Tooley. I'm an oculoplastic and orbital surgeon here at Mayo Clinic. Thyroid disease has a profound impact on the appearance and your quality of life. It's a very difficult condition to treat for both patients and providers. There's no real one-size-fits-all. It requires a team-based approach and customize care for you. That's why at Mayo Clinic, you'll see up to four different providers to provide a clinical plan of care for your specific thyroid eye disease. That plan will be discussed with you in the afternoon of your visit. You'll get a full rounded comprehensive plan so that you feel confident in the treatment of your thyroid eye disease.

Advanced treatment options

Mayo Clinic doctors use the latest medical approaches and surgical techniques to treat eye and vision complications of Graves' disease. New antibody-based therapies can stop the inflammation around the eyes and reverse some of the changes in eye appearance and function.

Your doctors may recommend a complex surgical technique called balanced orbital decompression surgery. For this approach, your otolaryngologist and eye surgeons work together. They use endoscopy and CT-guided navigation tools to remove bone that is constraining the eye muscles, optic nerve and fat in the space behind the eye. This reverses bulging of the eye and allows the eye to move back to a normal position.

Research to improve outcomes

Mayo Clinic doctors and scientists have long been leaders in Graves' disease research. The Thyroid Eye Disease Clinic specialists are committed to doing research that improves treatment and reduces side effects. Talk with your doctor about potential new diagnostic and therapeutic advances that might benefit you. Learn about their research activities.

See a list of publications about thyroid eye disease by Mayo Clinic doctors on PubMed, a service of the National Library of Medicine.

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June 14, 2023