Thyroid Eye Disease

Question 1

What happens in thyroid eye disease?

Answer 1

• Extraocular muscles of eye affected due to thyroid hormone dysregulation
• Retro-orbital inflammation and lymphocyte infiltration results in swelling of orbit

Question 2

How common is thyroid eye disease?

Answer 2

Seen in 25-50% of ppl with Graves

Question 3

What are causes/RF for thyroid eye disease?

Answer 3

1. smoking

2. Graves

Question 4

Does thyroid eye disease only affect hypothyroidism?

Answer 4

• disease may not correlate with thyroid disease (can be hypo or hyper)
• can be presenting feature of Grave’s

Question 5

When can thyroid eye disease get worse?

Answer 5

by treatment e.g. radioiondine

Question 6

What are symptoms of thyroid eye disease?

Answer 6

1. Eye discomfort
2. Grittiness
3. Increase tear production
4. Photophobia
5. Decreased acuity

Question 7

What are signs of thyroid eye disease?

Answer 7

1. Exophthalmos
2. Conjunctival oedema
3. Corneal ulceration
4. Papillodeomea

Question 8

What investigations may you do for thyroid eye disease?

Answer 8

• Clinical diagnosis

- CT, MRI or orbit may reveal enlarged eye muscle

Question 9

What is the lifestyle changes for managing thyroid eye disease?

Answer 9

1. Treat hypothyroidism or hyperthyroidism
2. Stop smoking
3. Sunglasses, avoid dust

Question 10

What are the medical management of thyroid eye disease?

Answer 10

1. Frensel prism to manage diplopia
2. Severe: high dose steroids e.g. IV methylprednisolone
3. Surgical decompression
4. Eventually Anti-TNFalpha antibodies e.g. infliximab