If you’ve taken radioactive iodine for hyperthyroidism (see the “Radioactive iodine treatment” section) and are now taking thyroid hormone, adjusting the level of the thyroid hormone won’t affect your eye disease. Severe cases of thyroid eye disease usually respond to irradiation of the muscles in the orbit. If irradiation doesn’t work or the case is severe enough, a surgeon can remove bone from the orbit, thus decompressing the tissues. While the eye doctor is removing bone from the orbit, another surgeon also attempts to remove all your thyroid tissue to eliminate antigens against which antibodies can be made, and the immune cells decline. After a doctor removes your thyroid, you need to take thyroid hormone replacement pills. In theory, it would be helpful for you to take an antithyroid drug (which I describe later in “Antithyroid pills”) along with thyroid hormone replacement, because the antithyroid drugs decrease immunity. But the effect of taking antithyroid drugs in conjunction with thyroid hormone hasn’t received enough careful study to warrant a recommendation.
Thyroid skin disease Thyroid skin disease, called pretibial myxedema and thyroid acropachy, occurs even less often than thyroid eye disease and is very severe in only 1 to 2 percent of patients with Graves’ disease. Pretibial myxedema is an abnormal thickening of the skin, usually in the front of the lower leg. Raised patches of skin are pink in appearance. Rarely, thyroid skin disease affects other parts of the body, such as the thighs, shoulders, and forearms. The skin problems may last for several months or longer, then gradually improve. If they become severe, they may respond to steroids applied under tight dressings. A study in the Journal of Clinical Endocrinology in February 2002 suggests that people who don’t receive steroids as treatment have about the same clinical course as those who do, so steroids may not be of much value in treating skin disease. With thyroid acropachy, a patient’s fingers become wider, and she may experience arthritic damage to the joints of her fingers. Fortunately, arthritic lesions usually cause only unsightly fingers and no symptoms. Patients with these finger changes don’t receive any particular treatment.
Recognizing Other Causes of Hyperthyroidism Although the vast majority of patients with hyperthyroidism have Graves’ disease, about 20 percent don’t. Hyperthyroid patients without Graves’ disease may have one of several other conditions that lead to the increased production of free T4 and T3 (thyroid hormones). The