Dysthyroid Ophthalmology

Question 1

Other names of dysthyroid ophthalmopathy

Answer 1

Thyroid eye disease
Graves’ ophthalmopathy
Thyroid-associated ophthalmopathy
Thyrotoxic exophthalmos

Question 2

Causes of thyrotoxicosis

Answer 2

Graves’ disease
Toxicmultinodular goiter
Toxic adenoma
Functioning thyroid carcinoma metastases
Activating mutation of TSH receptor
Iodine excess
Subacute thyroiditis
TSH secreting pituitary adenoma

Question 3

an autoimmune disease with usually presents in the 3rd-4th decade of life and affects women more commonly than men

Answer 3

Graves’ disease

Question 4

an autoimmune disorder that leads to overactivity of the thyroid gland

Answer 4

Graves disease

Question 5

overactivity of the thyroid gland

Answer 5

Hyperthyroidism

Question 6

a condition that occurs when the immune system mistakenly attacks healthy tissue

Answer 6

Graves’ disease

Question 7

Accounts for 60-80% of thyrotoxicosis

Answer 7

Graves’ Disease

Question 8

Most common cause of hyperthyroidism

Answer 8

Graves’ Disease

Question 9

Most common cause of unilatetal or bilateral proptosis in adults or children 20-50 years of age

Answer 9

Graves’ Disease

Question 10

Product of both environmental and genetic factors
Related factors: stress smoking

Answer 10

Graves’ Disease

Question 11

Pathogenesis of Graves’ Disease

Answer 11

Product of both environmental and genetic factors
Stress
Smoking

Question 12

clinical state of inappropriately high levels of circulating thyroid hormones (T3 and/or T4) in the body from any cause.

Answer 12

Thyrotoxicosis

Question 13

It is often incorrectly used interchangeably with hyperthyroidism, which is a form of thyrotoxicosis caused by excessive endogenous thyroid hormone production.

Answer 13

Thyrotoxicosis

Question 14

Normally the thyroid gland controls metabolism of the body and is important for regulating mood, weight, and mental and physical energy levels.

Answer 14

Graves disease

Question 15

is an autoimmune condition in which autoantibodies are directed against the thyroid-stimulating hormone (TSH) receptor.

Answer 15

Graves disease

Question 16

What is TSH

Answer 16

thyroid-stimulating hormone

Question 17

Risk factors for Graves disease

Answer 17

family history of hyperthyroidism or various other autoimmune disorders
•high iodine intake
•stress
•smoking

Question 18

The disease is classically characterized by the triad of goiter, exophthalmos, and pretibial myxedema.

Answer 18

Graves’ disease

Question 19

Cause of Graves’ disease

Answer 19

UNKNOWN
AUTOIMMUNE WITH LONG-ACTING
THYROID STIMULATOR

Question 20

Triad of symptoms of Graves’ disease

Answer 20

HYPERTHYROIDISM
• OPHTHALMOPATHY
• DERMOPATHY

Question 21

Symptoms of Graves’ disease

Answer 21

•hyperactivity, irritability ,dysphoria
•Heat intolerance and sweating
•Palpitations
•Fatigue and weakness
•Weight loss with increased appetite
•Diarrhea
•Polyuria
•Oligomenorrhea, loss of libido

Question 22

Signs of Graves’ disease

Answer 22

Tachycardia
•Tremor
•Goiter
•Warm, moist skin
•Muscle weakness
•Lid retraction or lag
•gynecomastia

Question 23

5 types of thyroid eye disease

Answer 23

Soft tissue involvement
Eyelid retraction
Proptosis
Optic neuropathy
Restrictive myopathy

Question 24

Signs of soft tissue involvement

Answer 24

Periorbital and lid swelling
Conjunctival hyperaemia
Chemosis
Superior limbic keratoconjunctivitis

Question 25

Occurs in about 50%

Answer 25

Eyelid retraction Proptosis

Question 26

Signs of eyelid retraction

Answer 26

Bilateral lid retraction Bilateral proptosis Unilateral lid retraction Unilateral proptosis Lid lag in downgaze

Question 27

Occurs in about 50% Uninfluenced by treatment of hyperthyroidism Axial and permanent in about 70% May be associated with choroidal folds

Answer 27

Proptosis

Question 28

Treatment for proptosis

Answer 28

Systemic steroids radiotherapy Surgical decompression

Question 29

Occurs in about 5% Early defective color vision Usually normal disc appearance

Answer 29

Optic neuropathy

Question 30

Caused by optic nerve compression at orbital apex by enlarged recti Often occurs in absence of significant proptosis

Answer 30

Optic neuropathy

Question 31

Occurs in about 40% Due to fibrotic contracture

Answer 31

Restrictive myopathy

Question 32

Most common in restrictive myopathy

Answer 32

Elevation defect

Question 33

Less common in restrictive myopathy

Answer 33

Abduction defect

Question 34

Uncommon in restrictive myopathy

Answer 34

Depression defect

Question 35

Rare in restrictive myopathy

Answer 35

Adduction defect

Question 36

Many scoring systems have been used to gauge the extent and activity of the orbital changes in Graves' disease.

Answer 36

0 = No signs or symptoms 1 = Only signs (lid retraction or lag), no symptoms 2 = Soft-tissue involvement (periorbital edema) 3 = Proptosis (>22 mm) 4 = Extraocular-muscle involvement (diplopia) 5 = Corneal involvement 6 = Sight loss

Question 37

Treatment of Hyperthyroidism

Answer 37

Antithyroid medications –Methimazole or tapazole –Propylthiouracil •Radioactive iodine •Surgery