It Takes a Team
How one patient benefited from a multidisciplinary approach
to Graves' eye disease
Ester M. Skutt, of Holt, Michigan, remembers vividly the day she was diagnosed with Graves' disease in October 2009. "I was frightened," says the former nurse. "I knew it was a pretty bleak situation. I had taken care of patients with the disease." A complex autoimmune disorder, Graves' disease results in the overproduction of thyroid hormones, or hyperthyroidism. The condition affects over 3 million Americans.
One year later, in December 2010, Ms. Skutt developed a cluster of "blisters" on her eyes. "I knew that with Graves' disease there was a possibility that my eyes could be involved," she says. Her greatest fear was that her symptoms could be related to Graves' eye disease, a complication that results in swelling of the eyelids, a constant stare, eyelid retraction, and double vision. Left untreated, the disorder can lead to permanent vision loss.
Ms. Skutt's ophthalmologist in nearby Lansing started her on a regimen of steroid therapy to address the blistering. After two doses and strong drug intolerance, she found herself in the hospital with atrial fibrillation, an irregular heartbeat often associated with congestive heart failure. Days later, she was referred to Kellogg's Raymond S. Douglas, M.D., Ph.D., a specialist in Graves' eye disease and renowned orbital, facial plastic and reconstructive surgeon.
"Ms. Skutt's inflammation and eye bulging had progressed rapidly and she was beginning to lose vision," says Dr. Douglas. "Given her intolerance for steroids, we felt it would be reasonable to try alternative anti-inflammatory therapies in conjunction with the care of a team of rheumatologists. After two infusions, her disease regressed and we were able to stabilize her thyroid function. Most of her pain also ceased."
To help patients like Ms. Skutt receive expert care for this complex condition, the Kellogg Eye Center has formed its Thyroid Eye Disease Center, which brings together specialists from multiple disciplines to provide integrated care for individuals with thyroid disorders. Surgeons from Kellogg's oculoplastics service are at the core of the Center, coordinating clinical care as well as participating in research aimed at discovering new therapies for Graves' and thyroid disorders.
In the months that followed, Ms. Skutt underwent orbital decompression surgery to move her eyes back into place followed by surgery to correct her double vision. "It was a terrific team effort," she says. "I saw specialists in orbital surgery, strabismus, and endocrinology at Kellogg—and a specialist in rheumatology at the University of Michigan Health System. The communication between doctors was fantastic."
Dr. Douglas' office serves as a destination for patients with Graves' eye disease. "If Ms. Skutt had to go through the normal referral channels, it would have been months of delay and time lost," says Dr. Douglas. "With one appointment, her care was consolidated and she had a rapid treatment plan."
Ms. Skutt has returned to her normal life. "I'm doing fantastic," she says. "My eyes look better than they did before I was diagnosed with Graves' disease. The whole experience was just unbelievably good."