Thyroid Eye Disase Flashcards
If patient presents with bilateral proptotic eyes, what type of scan should we get?
CT scan
If a patient presents with a unilateral proptotic eye, what type of scan should we get?
MRI
In TED, whereever the eye cannot go, the ______ muscle is enlarged.
opposite
Absence o exophthalmos may mean what?
posterior decompression of ON
What’s the most reliable sign of TED?
Upper lid retraction
A patient that complains of their jelly roll edema in TED will say its worse when?
Worse when waking up and if they sleep on their back
When performing the curtain test, the left eye looks ptotic. You pin it up, what happens to the right eye if OS is truly ptotic?
OD will droop
What are the 3 muscles affected in TED consecutively?
- IR
- MR
- SR
If IR is affected, which way will the patient have problems looking?
- issues looking up
- always opposite of swollen muscle
What will be the first ocular symptom of TED?
Dry eye
If patient has a hard time looking out, if you take IOP what will happen?
IOP will increase
What are the labs that should be ordered for a possible TED patient that has never been dx?
- Serum TSH
- T3 + T4
- Anti-thyroid antibodies
- Thyroid Stimulating Immunoglobulin (TSI)
Which lab workup is important to determine if TED is present
- Anti-thyroglobulin Ab
- Thyroperosidase Ab
What can the patient to do decrease the symptoms of TED and have a better prognosis?
stop smoking!
What is the tx if there’s significant EOM enlargement?
- Oral steroids for acute tx
2. Orbital decompression if compressive optic neuropathy is present
When is the only time EOM muscle is allowed?
TED must be stable and not worsening (usually ~ 2 years)
What % of MG patients will present with a thymoma?
10%
Does MG affect the pupils?
No!
If the patient has purely ocular MG, what will be the symptoms?
diplopia and ptosis
If the patient has genralized MG, what will be their symptoms?
Ocular symptoms and upper/lower limb weakness
MG is characterized by a decrease in the number of ____ receptors?
ACH receptors due to antibodies binding to them
MG is found in what type of ppl?
- Young women = 15-20
2. Old men = 50-60
60% of MG patients will have an initial presenting ocular sign. Why?
the low diplopic threshold
- a small misalignment of the eyes can cause DV
When a MG patient looks down and then straight ahead, the upper lid overshoots and then comes back down. What’s this called?
Cogan’s lid twitch
