Grave's Disease Flashcards
graves disease is the number one cause of
hyperthyroidism
what is graves disease
an autoimmune disorder of the thyroid gland which results in TSH autoantibodies stimulating the TSH receptor causing high T3 and T4 and LOW TSH
classic presentation
thyrotoxicosis, goitre, exopthalmos
pathophysiology
IgG autoantibodies bind to and activate G protein coupled TSH receptors on follicular cells causing excessive production of thyroid gland
pathophysiology of opthalmopathy
TSH receptos antibodies bind to the receptors on orbital fibroblasts initiating the characteristic eye changes
pneumonic for classification of thyroid eye disease
NOSPECS
No signs or symptoms
Only signs such as upper lid retraction no symptoms
Soft tissue involvement
Proptosis
Extra-Oscular muscle involvement
Corneal involvement
Sight loss due to optic nerve involvement
Graves opthalmopathy
- exophthalmos
- periorbital oedema and chemosis
- lagophythalmos
- proptosis
- ophthalmoplegia
- if there is concurrent thyrotoxicosis then upper eye lid retraction and lid lag
- visual loss
exopthalmos
severe proptosis with whiteness of the sclera visible below or all around the iris
chemosis
swelling of the conjunctiva
lagophythalmos
inability to close the eyes completely
proptosis
protrusion of eye anteriorly out of the orbit beyond the level of the supraorbital ridge
ophthalmoplegia
paralysis or weakness of the muscles of the eye, upward gaze is affected first
upper eye lid retraction
visible white scale above iris caused by increased tone and spasm of levator palpebrae superioris
lid lag is known as
von Gräfes sign
visual loss is due to
corneal exposure and optic nerve compression
