2.1 Thyroid Eye Disease I Flashcards
What is Graves disease?
A type of autoimmune disorder that leads to over activity of the thyroid gland and is termed hyperthyroidism. As a result the thyroid gland enlarges and excess hormones increase the metabolism.
What are symptoms of Graves disease (hyperthyroidism)?
Weight loss – despite increased appetite
Anxiety, restlessness, tremors, irritability, insomnia.
Heat intolerance
Chest pain, shortness of breath
Muscle weakness
Goitre (enlarged thyroid gland)
What are the treatment methods for Graves disease?
Medicine
Radioactive iodine treatment
Surgery
Explain medication use in Graves disease
thionamides (stop the thyroid gland producing excess hormones). Main types used are carbimazole and propylthiouracil. Patients usually need to take the medication for 1 to 2 months before they notice any benefit.
Explain radioactive iodine treatment in Graves disease
Used to destroy cells in the thyroid gland thus reducing the amount of hormones it can produce. Patients consume a drink or capsule containing iodine and a low dose of radiation which is absorbed by the thyroid, most people only require a single treatment. It can take a while for full benefits to be felt and so patients may need to take medicine for a short time.
What is the name of the surgery in Graves disease?
thyroidectomy
What are the side effects of medication in thyroid eye disease
Feeling sick
Headaches
Aching joints
Altered taste
Upset stomach
Itchy rash
Agranulocytosis (sudden drop in blood cell count) which can compromise immunity – LESS COMMON
What are the precautions for radioactive iodine treatment?
Avoid prolonged close contact with children and pregnant women for a few days or weeks.
Women should avoid getting pregnant for at least 6 months.
Men should not father a child for at least 4 months.
Radioactive iodine treatment is not suitable for women who are pregnant or breastfeeding. Its also not suitable if your overactive thyroid is causing severe eye problems (TED).
When is a thyroidectomy the best choice?
The thyroid gland is severely swollen because of a large goitre.
There are severe eye problems caused by an overactive thyroid.
The patient is unsuitable for other, less invasive treatments.
The symptoms return after trying other treatments.
What is the main positive to thyroidectomy?
Removing all the thyroid gland is usually recommended because it stops the symptoms of hyperthyroidism coming back.
What is the main negative to thyroidectomy?
The patient will need to take thyroid medication (eg levothyroxine) for the rest of their life to make up for not having a thyroid gland.
What characteristics display the highest incidence of TED?
More common in women however men are more likely to suffer from more severe disease.
25% of Graves disease patients will develop TED at some point.
Smoking increases chances of TED.
Most common in middle age (40-60 years).
What are the signs of TED?
Upper lid retraction – accentuated by proptosis and in attempted up gaze when the IR are tight.
Reduced frequency of blinking
Lid lag on down gaze
Staring appearance
Conjunctival injection – (red eyes) sometimes over the site of rectus muscle insertion
Chemosis – Swelling on the conjunctiva
Oedema of the lids – build-up of fluid
Proptosis – protrusion of the eye
What are the symptoms of TED?
Diplopia
Blurred vision/visual loss
Epiphoria
Grittiness of eyes
General ocular discomfort/pain
Photophobia
What is the likely strabismus in TED?
The most commonly effected muscle is the inferior rectus (IR), then the MR, SR and LR.
Limited elevation is most common but there may also be limited abduction, limited depression, and limited adduction.
