graves disease - hyperthyroidism Flashcards
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Most common cause of thyrotoxicosis is ?
Graves’ disease
clinical features of graves disease ?
non tender goitre
pretibial myxoedema-orang peel skin lesions
thyroid acropachy, a triad of:
digital clubbing
soft tissue swelling of the hands and feet
periosteal new bone formation
Eye signs of Graves’ disease
proptosis (bulging of the eyes)
excessive eye watering,
double vision,
change in visual acuity and eyelid retraction
conjunctival oedema
optic disc swelling
retro-orbital inflammation
What is the most important modifiable risk factor for the development of thyroid eye disease?
SMOKING
What may exacerbate eye symptoms in Graves’ disease ?
radioiodine
Diagnosis of Graves’ disease
TSH receptor stimulating antibody -
Anti -TPO (thyroid peroxidase
antibody - auto antibody -in 75 percent)
Diagnosis of Graves’ disease in thyroid testing
TSH is low
T4 is high
Diagnosis of graces disease in thyroid scintigraohy ?
diffuse, homogenous, increased uptake of radioactive iodine
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Tx of graves orbitopathy ?
topical lubricants may be needed to help prevent corneal inflammation caused by exposure
steroids!
radiotherapy
surgery
Treatment of graves disease ?
Carbimazole is the correct answer.
what is the side effect of carbimazole ?
agranulocytosis
inability to close the eyelids may lead to sore, dry eyes. If severe and untreated patients
can be at risk of exposure keratopathy
Carbimazole mechanism of action ?
blocks thyroid peroxidase from coupling and iodinating the tyrosine residues on thyroglobulin → reducing thyroid hormone production
