Dysthyroid Ophthalmology Flashcards
Other names of dysthyroid ophthalmopathy
Thyroid eye disease
Graves’ ophthalmopathy
Thyroid-associated ophthalmopathy
Thyrotoxic exophthalmos
Causes of thyrotoxicosis
Graves’ disease
Toxicmultinodular goiter
Toxic adenoma
Functioning thyroid carcinoma metastases
Activating mutation of TSH receptor
Iodine excess
Subacute thyroiditis
TSH secreting pituitary adenoma
an autoimmune disease with usually presents in the 3rd-4th decade of life and affects women more commonly than men
Graves’ disease
an autoimmune disorder that leads to overactivity of the thyroid gland
Graves disease
overactivity of the thyroid gland
Hyperthyroidism
a condition that occurs when the immune system mistakenly attacks healthy tissue
Graves’ disease
Accounts for 60-80% of thyrotoxicosis
Graves’ Disease
Most common cause of hyperthyroidism
Graves’ Disease
Most common cause of unilatetal or bilateral proptosis in adults or children 20-50 years of age
Graves’ Disease
Product of both environmental and genetic factors
Related factors: stress smoking
Graves’ Disease
Pathogenesis of Graves’ Disease
Product of both environmental and genetic factors
Stress
Smoking
clinical state of inappropriately high levels of circulating thyroid hormones (T3 and/or T4) in the body from any cause.
Thyrotoxicosis
It is often incorrectly used interchangeably with hyperthyroidism, which is a form of thyrotoxicosis caused by excessive endogenous thyroid hormone production.
Thyrotoxicosis
Normally the thyroid gland controls metabolism of the body and is important for regulating mood, weight, and mental and physical energy levels.
Graves disease
is an autoimmune condition in which autoantibodies are directed against the thyroid-stimulating hormone (TSH) receptor.
Graves disease
What is TSH
thyroid-stimulating hormone
Risk factors for Graves disease
family history of hyperthyroidism or various other autoimmune disorders
•high iodine intake
•stress
•smoking
The disease is classically characterized by the triad of goiter, exophthalmos, and pretibial myxedema.
Graves’ disease
Cause of Graves’ disease
UNKNOWN
AUTOIMMUNE WITH LONG-ACTING
THYROID STIMULATOR
Triad of symptoms of Graves’ disease
HYPERTHYROIDISM
• OPHTHALMOPATHY
• DERMOPATHY
Symptoms of Graves’ disease
•hyperactivity, irritability ,dysphoria
•Heat intolerance and sweating
•Palpitations
•Fatigue and weakness
•Weight loss with increased appetite
•Diarrhea
•Polyuria
•Oligomenorrhea, loss of libido
Signs of Graves’ disease
Tachycardia
•Tremor
•Goiter
•Warm, moist skin
•Muscle weakness
•Lid retraction or lag
•gynecomastia
5 types of thyroid eye disease
Soft tissue involvement
Eyelid retraction
Proptosis
Optic neuropathy
Restrictive myopathy
Signs of soft tissue involvement
Periorbital and lid swelling
Conjunctival hyperaemia
Chemosis
Superior limbic keratoconjunctivitis
Occurs in about 50%
Eyelid retraction
Proptosis
Signs of eyelid retraction
Bilateral lid retraction
Bilateral proptosis
Unilateral lid retraction
Unilateral proptosis
Lid lag in downgaze
Occurs in about 50%
Uninfluenced by treatment of hyperthyroidism
Axial and permanent in about 70%
May be associated with choroidal folds
Proptosis
Treatment for proptosis
Systemic steroids
radiotherapy
Surgical decompression
Occurs in about 5%
Early defective color vision
Usually normal disc appearance
Optic neuropathy
Caused by optic nerve compression at orbital apex by enlarged recti
Often occurs in absence of significant proptosis
Optic neuropathy
Occurs in about 40%
Due to fibrotic contracture
Restrictive myopathy
Most common in restrictive myopathy
Elevation defect
Less common in restrictive myopathy
Abduction defect
Uncommon in restrictive myopathy
Depression defect
Rare in restrictive myopathy
Adduction defect
Many scoring systems have been used to gauge the extent and activity of the orbital changes in Graves’ disease.
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
Treatment of Hyperthyroidism
Antithyroid medications
–Methimazole or tapazole
–Propylthiouracil
•Radioactive iodine
•Surgery
