
	Medical Edge


	About

	Television

	Radio

	Newspaper

		Participating Newspapers

	Magazine

	Contact


	About Mayo Clinic

	Make an Appointment at Mayo Clinic

Medical Edge Newspaper Column from Mayo Clinic

SEEK TREATMENT NOW, NOT LATER, FOR GRAVES’ DISEASE

DEAR MAYO CLINIC: I can tell something’s wrong with me, but I need to keep working. My eyes are bulging and I look a little bug-eyed, and sunlight really irritates them. All of this is a problem because I’m a construction worker and need to work outside. My family doctor thinks it might be a complication of Graves’ disease. She has suggested I seek out a specialist at the university. I’ve never heard of this disease and now all of a sudden I’m supposed to take time off during my busy season. What is this, and can it wait until there’s snow? — Milwaukee

ANSWER: First, I’ll answer your question about Graves’ disease. Then, I’ll explain why I would encourage you to get help now to minimize the health risks associated with the disorder.

Worldwide, Graves’ disease is the most common autoimmune disorder — a condition in which an immune-system mix-up causes the body to attack itself. In this case, the thyroid gland produces too much of the hormone thyroxine. A surplus of thyroxine can cause a range of medical problems, including nervousness, insomnia, heat intolerance, and a rapid or irregular pulse. In many cases, eye problems (Graves’ ophthalmopathy) may be associated with this condition.

Graves’ ophthalmopathy can seriously affect vision. When inflammation develops around the eye, the fat and muscle tissues within the eye socket enlarge. This may result in forward movement of the eyeball, and the prominent “bug-eyed” look you describe. In addition, muscle structures may make the eyelids retract, also contributing to the bulging appearance of the eye.

A combination of this forward movement and eyelid retraction may cause the corneas to dry out, leading to irritation, ulceration and even vision loss. Some patients also get double vision. Most seriously, swelling of the tissues behind the eye can produce compression or stretching of the optic (sight) nerve, causing permanent vision loss.

Your doctor is wise in advising you to see an ophthalmologist with expertise in treating this disease. I encourage you to make the appointment soon.

John Woog, M.D., Ophthalmology, Mayo Clinic, Rochester, Minn.

Additional Resources:
Treatment of Graves' Disease
Appointment Information
More Information on Graves' Disease

DEAR MAYO CLINIC: I’ve been told I have abnormal peripheral arterial disease with .56 ankle-brachial index and plaque buildup. What does this mean for my health? — Racine, Wis.

ANSWER: Peripheral arterial disease is usually caused by atherosclerosis — a hardening or narrowing of the arteries. It means that arteries supplying blood to your legs become clogged or partially clogged.

For some people, PAD causes pain when walking, most often in your calf muscles. The majority of people with PAD don’t have pain and the condition is undetected. But it’s better to know — because PAD is a potentially serious condition that is associated with an increased risk of heart attack, stroke and death from cardiovascular disease.

The ankle-brachial index is a comparison of blood pressure in your ankle and the blood pressure in your arm. Your ankle-brachial index reading of .56 indicates a moderately increased risk of heart attack and stroke.

You can immediately take steps to reduce your risk. Healthy lifestyle changes stop disease progression for about 70 percent of people with PAD. Get your cholesterol levels under control. Don’t use tobacco. Control diabetes and high blood pressure. Exercise.

I suggest a structured walking program on a treadmill for 30 minutes, five days a week. If walking causes pain, stop or slow down when pain starts and resume as it subsides. You’ll find you can eventually double or even triple the distance covered without pain.

If lifestyle changes alone don’t work, other treatment options are available, including drugs to lower cholesterol and blood pressure. Aspirin may decrease the risk of heart attack and stroke. More invasive options include angioplasty, a procedure to widen a blocked artery, or an operation to remove or bypass an artery.

Good foot care also is important — avoid foot injuries and seek prompt treatment for sores or wounds. Reduced blood flow to your feet means sores don’t heal quickly. An infected foot sore can infect the bone, which can lead to amputation.

Check with a vascular medicine specialist to confirm your diagnosis and determine a tailored treatment program.

Leslie Cooper, M.D., Cardiovascular Diseases, Mayo Clinic, Rochester, Minn.

Additional Resources:
Information on Peripheral Arterial Disease
Appointment Information
More Information on Peripheral Arterial Disease
- - -

Medical Edge from Mayo Clinic is an educational resource and doesn’t replace regular medical care. To e-mail a question, go to www.mayoclinic.org, or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.