Thyroid Eye Disease

Question 1

Define exophthalmos

Answer 1

Bilateral proptosis of the eyeball out of the socket

Question 2

exophthalmos is a unique feature of which thyroid condition

Answer 2

Graves Disease

Question 3

Grave’s exophthalmos is most commonly seen in which patient group

Answer 3

Smokers

Question 4

Describe the pathogensis of Graves Disease

Answer 4

TSH receptor autoantibodies are produced by the immune system which mimics TSH.

These antibodies stimulate the TSH receptors on the thyroid causing hyperthyroidism

Question 5

Describe the pathogenesis of Grave’s exophthalmos

Answer 5

Pathogenesis of Grave’s exophthalmos is not fully understood

Off target effect of the TSH receptor autoantibodies causes retro-orbital inflammation, swelling and hypertrophy

The inflammation results in glycosaminoglycan and collagen deposition in the extra-ocular muscles

Question 6

Name two risk factors for graves exophthalmos

Answer 6

Family history of autoimmune disease, particularly Grave’s disease

Smoking worsens the disease

Question 7

Name some of the clinical features of graves exophthlamos

Answer 7

Proptosis

Periorbital oedema

Lid retraction

Eye pain

Visual loss

Question 8

How is Graves Exophthalmos managed

Answer 8

Dependent on disease severity

Topical lubricants e.g. artificial tears

Smoking cessation

Question 9

When should a patient with graves exophthalmos be referred to ophthalmology

Answer 9

If there is evidence of optic nerve compression, corneal opacity or inability to close an eye

Question 10

In severe graves exophthalamos (under the supervision of a opthalamologist)

What 3 medications could they offer

Answer 10

Steroids

Radiotherapy

Surgical decompression