A4. Thyroid disease

Question 1

what is graves disease? what is the cause and risk factors?

Answer 1

autoimmune condition where your immune system mistakenly attacks your thyroid which causes it to become overactive. About 3 in every 4 people with an overactive thyroid gland have a condition called Graves’ disease.

the cause of Graves’ disease is unknown, but it mostly affects young or middle-aged women and often runs in families. Smoking can also increase your risk of getting it.

Question 2

what is the main symptom of thyroid eye disease?

Answer 2

very common orbital disorder and most common cause of both bilateral and unilateral proptosis in adults.

Question 3

what are 5 clinical features of TED? SLPOR

Answer 3

soft tissue involvement
lid retraction
proptosis
optic neuropathy
restrictive myopathy

Question 4

what are the 5 consequence of soft tissue involvement in TED?

Answer 4

1. Grittiness/FB sensation
   ­2. Red eyes/hyperaemia – sign of inflammatory activity­
2. Lacrimation – tear insufficiency and instability
   ­4, Photophobia
   ­5. Corneal involvement exacerbated by lid retraction

Question 5

what are the 4 consequence of lid retraction in TED? ROFS

Answer 5

1. Retraction of upper and lower lid in 50% of patients with Graves disease­—sclera exposed
2. Overaction of Muller muscle
   ­3. Fibrotic contracture of levator palpebrae and inferior rectus
   ­4. “staring” appearance
   ­

Question 6

what are the 2 consequences of proptosis in TED?

Answer 6

1. Bulging of eye forward, Unilateral or bilateral
   ­2. Severe proptosis may compromise lid closure, leading to exposure keratopathy and other cornea complications

Question 7

what are the 3 consequence of restrictive myopathy in TED?

Answer 7

­1. Ocular motility restricted by inflammatory edema/fibrosis Occur in 30-50% of patients­
2. Most commonly elevation defect

Question 8

what are the 5 consequence of optic neuropathy in TED?

Answer 8

1. Caused by compression of the optic nerve or blood supply­
2. Occur in up to 6% of patients
   ­3. May lead to central vision impairment (VA usually reduced)­
3. Colour desaturation­
4. Visual field defect can be central or paracentral

Question 9

what are the 9 SSx of TED?

Answer 9

1. photophobia
2. corneal exposure
3. lid lag
4. lid retraction and stare
5. Increased IOP
6. proptosis (protrusion of the eyeball)
7. ophthalmolplegia (paralysis of muscles within or around the eye)
8. FB sensation
9. tearing

Question 10

Mx for TED?

Answer 10

1.Lid retraction: ­lid taping during sleep­, surgery
­
2. Ocular surface involvement: ­Lubricants, ­topical anti-inflammatory agents­

3. Proptosis:­ systemic steroids­
4. Restrictive myopathy: ­initially prisms, ­surgery­
5. Optic neuropathy: ­systemic steroids