Thyroid Eye Disease Flashcards
1
Q
Normal control of thyroid
A
- thyrotropin releasing hormone is produced by the hypothalamus
- acts on the anterior pituitary gland, releasing TSH
2
Q
Abnormal control of thyroid
A
- hyperthyroidism in graves
- targets the TSH receptor and mimics the effect of normal TSH resulting in overstimulation of the thyroid gland
- swelling of the gland
- overproduction of T4 and T3
3
Q
Causes of thyroid eye disease
A
- Graves’ disease
- thyroiditis
- toxic multi nodular
- toxic thyroid nodule
- self administered thyroid hormones
4
Q
Pathophysiology of TED
A
- acute/active inflammatory
- late/inactive phase
5
Q
Features of the active phase
A
- connective tissue inflammation
- activation of EOM fibroblasts
- increased orbital volume
- these then attract water
- inflammatory myopathy resulting from the autoimmune process
6
Q
Features of connective tissue inflammation
A
- redness
- mild ocular discomfort
- preorbital swelling
- pain or motility
7
Q
5 signs of TED
A
- soft tissue involvement
- restrictive myopathy
- lid retraction
- proptosis
- optic neuropathy
8
Q
Other signs of TED
A
- chin elevation
- hypophoria/tropia usually first deviation
- with/without head turn
- enlarged fusion range
- raised iop on elevation/attempted elevation
9
Q
Typical order of EOM imitation
A
- inferior rectus
- medial rectus
- superior rectus
- lateral rectus
10
Q
Features of soft tissue inflammation
A
- periorbital swelling
- conjunctival swelling
- conjunctival injection
- reduced tear production
11
Q
Signs of optic nerve compression in TED
A
- loss of VA
- RAPD
- colour vision defects
- possible optic atrophy
- pinhole to make sure not refractive
- visual field defects
- mild or no disc swelling
- VEP showing reduced amplitude
12
Q
Inactive phase features
A
- cicatricial phase
- reduction in proptosis and swelling
- fibrosis and muscle contraction
- corneal exposure due to retraction of lids
13
Q
Systemic symptoms of hyperthyroidism
A
- weight loss
- sweating
- lethargy
- tremour
- intolerance of heat
- reduced tolerance of cold
- increased appetite
- increased heart rate
