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X. neuro ophthalmology > Thyroid Eye Disease > Flashcards

Thyroid Eye Disease Flashcards

1
Q

What is the hallmark of orbital disease?

A

Proptosis/Exophthalmos

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2
Q

T/F: MRI/CT scan is necessary for diagnosis of TED

A

FALSE

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3
Q

Proptosis + Adenopathy may be associated with…

A

Systemic lymphoma or METS

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4
Q

5 Physical (non-ocular) tests for proptotic patients

A
  1. Blood tests
  2. Thyroid palpation
  3. Lymph node palpation
  4. Sinus testing
  5. Body temperature
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5
Q

What is a normal exophthalmometer measurement?

A

Normal is 17 mm
Most people are less than 22

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6
Q

Intraocular exophthalmometer difference of ___ mm is considered abnormal

A

2 mm

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7
Q

How often should exophthalmometry be measured in TED patients?

A

1-3 months

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8
Q

Exophthalmometer measurement increase of ___ mm indicates progression of TED.

A

2 mm

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9
Q

T/F: Collier’s Sign is found in Thyroid Eye Disease

A

FALSE

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10
Q

(+) Collier’s in children can indicate…

A
  1. Congenital aqueduct stenosis
  2. Hydrocephalus
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11
Q

What is the most common cause of Orbital Disease

A

TED

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12
Q

TED is also referred to as

A
  • Graves Ophthalmopathy
  • Thyroid-Associated Orbitopathy
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13
Q

TED is more common in ____ (males/females) and more severe in ___ (males/females)

A

Common — Females
Severe — Males

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14
Q

Is TED an immune or an inflammatory disorder?

A

BOTH

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15
Q

Why is TED related to edema?

A

Increase in “materials” attracts fluid

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16
Q

What are 3 possible mechanisms for TED?

A
  1. Inflammation of perioribital soft tissue
  2. Overproduction of glycosaminoglycans
  3. Hyperplasia of adipose tissue
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17
Q

T/F: Most patients with TED also have MG

A

FALSE — only 1-2%
Still recommended to perform chair-side MG tests on all TED patients

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18
Q

TED usually most presents at age…

A

20-60

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19
Q

T/F: controlled Thyroid Disease rarely manifests ocular symptoms

A

FALSE

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20
Q

T/F: TED can occur in pts with hypothyroidism

A

TRUE

Hyper, hypo, or euthyroid

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21
Q

What percent of Euthyroid patients with TED will eventually develop systemic thyroid disease?

A

70%

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22
Q

Most common tumor DDx for TED in adults

A

Lymphoma

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23
Q

T/F: IOIS is more common in adults, but can occur in pediatric patients

A

TRUE

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24
Q

Most common DDx for TED in adults

A
  1. Tumor (esp Lymphoma)
  2. Infectious (Preseptal or Orbital)
  3. Dural Sinus Fistula
  4. Metastasis
  5. IOIS
25
Q

DDx for TED in children (3)

A
  1. Congenital
  2. Infectious (Preseptal or Orbital)
  3. Malignancies (rhadbomyosarcoma**, neuroblastoma, Ewing’s, and retinoblastoma)
26
Q

NOSPECS classification

A

No physical symptoms
Only signs (no symptoms)
Soft tissue involvement
Proptosis
EOM involvement
Corneal involvement
Sight loss

27
Q

Describe the early stage of TED

A

Non-specific inflammatory signs/symptoms

28
Q

Describe the inactive stage of TED

A
  1. Lid abnormalities (retraction, edema, lagophthalmos)
  2. Diplopia/vision loss
29
Q

Vision loss associated with TED is usually due to (2)

A

Optic neuropathy or corneal involvement

30
Q

Is suspecting TED, but pt c/o pain, the diagnosis is more likely…

A
  1. IOIS
  2. Infections
  3. Tumor
31
Q

TED onset is typically ___ (gradual/sudden)

A

Gradual

32
Q

What are the limitations of the NOSPECS classification system?

A

Does not distinguish inflammatory progression from non-inflammatory progression

33
Q

___ is one of the most popular classification methods for TED today

A

Clinical Activity Score (CAS)

34
Q

Why was the CAS system formed?

A

To discriminate easily between active and quiescent stages of TED

35
Q

What CAS score is indicative of active TED?

A

Above 3/7 on initial visit or 4/10 on successive visits

36
Q

What are the main systems graded by the VISA?

A

Vision
Inflammatory
Strabismus
Appearance/Exposure

37
Q

What inflammatory score on the VISA scale warrants ‘aggressive’ therapy?

A

5/10

38
Q

What is the main benefit of EUGOGO?

A

Picture atlas for comparison

39
Q

Studies show that ____% of orbitipathy pts improve, ___% remain stable, and ___% worsen

A

50% improve
35% remain stable
15% worsen

40
Q

General “First Step” Treatments for TED

A

Diamox (CAI)
Artificial Tears
Tape Lids at night
Elevate Head

Prism
Avoid pre-op iodine
Gazing in all directions
Educate patient
Steroid injections

41
Q

Treatment for mild TED?

A

“General first steps” + oral selenium (100 µg 2x/day)

42
Q

Benefits of selenium

A

Improves quality of life, reduces ocular involvement, and slows progression of TED

43
Q

Which delivery method proved to have a highest response rate?

A

IV (82%) vs oral (53.4%)

44
Q

What are benefits of IV steroids?

A
  1. Higher response
  2. Fewer side effects
  3. Shorter tx time
  4. Lower relapse rate
45
Q

Cumulative dose of steroids should not exceed…

A

8g

46
Q

Commonly used steroid regimen for moderate TED

A

500 mg methylprednisolone x 6 wk
Then, 250 mg x 6 weeks

47
Q

CI for steroid treatment of TED

A
  1. Liver dysfunction/recent hepatitis
  2. Severe CVD or HTN
  3. Psych disorders
  4. Uncontrolled DM

for all pts, liver enzymes, glucose, and BP should be monitored monthly

48
Q

Management for moderate TED

A

Steroids + Orbital radiotherapy

49
Q

Management of Sight-Threatening TED

A

High dose IV steoroids (500-1000 mg for 3 days)

If poor response within 2 weeks or if (+) choroidal folds or eyeball subluxation, orbital decompression!!

50
Q

Selenium can be found in… (food)

A

Meat, fish, eggs, cereals…

51
Q

What is the general mechanism for selenium that improves TED

A

Involved in cellular redox state —> has antioxidant and immunomodulatory effects

52
Q

Most feared complication of TED?

A

Optic neuropathy

53
Q

T/F: vision loss can be reversed with TED

A

TRUE; medial and lateral decompression highly successful in reversing VL

54
Q

Common VF defects with ON neuropathy (4)

A
  1. Enlarged blind spots
  2. Nerve fiber defects
  3. Central or cecocentral defects
  4. General constriction
55
Q

T/F: only a small percentage of TED pts experience vision loss

A

TRUE (2-9%)

56
Q

TED f/u’s should include:

A
  1. VF
  2. Color vision (monocular)
  3. Contrast sensitivity
  4. VEP
  5. R/o pallor, swelling, and hyperemia
  6. Assess for MG
57
Q

Long-standing muscular edema along with increased production of collagen leads to…

A
  1. Atrophy
  2. Fibrosis
  3. Sclerosis (of EOM)
  4. Restrictive strab
58
Q

F/U’s for TED should occur every ____

A

1-3 months

X. neuro ophthalmology (10 decks)

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