Thyroid eye disease Flashcards
What percentage of patients with Graves’ disease are affected by thyroid eye disease?
Thyroid eye disease affects between 25-50% of patients with Graves’ disease.
What is the suspected cause of thyroid eye disease?
It is thought to be caused by an autoimmune response against an autoantigen, possibly the TSH receptor, leading to retro-orbital inflammation.
What are the consequences of inflammation in thyroid eye disease?
The inflammation results in glycosaminoglycan and collagen deposition in the muscles.
What is the most important modifiable risk factor for thyroid eye disease?
Smoking is the most important modifiable risk factor for the development of thyroid eye disease.
How can radioiodine treatment affect thyroid eye disease?
Radioiodine treatment may increase the inflammatory symptoms seen in thyroid eye disease.
What percentage of patients with Graves’ disease may develop or worsen eye disease after radioiodine treatment?
In a recent study, around 15% developed or had worsening of eye disease.
What medication may help reduce the risk of worsening thyroid eye disease?
Prednisolone may help reduce the risk.
What thyroid status may patients present with in thyroid eye disease?
The patient may be eu-, hypo- or hyperthyroid at the time of presentation.
What are some common features of thyroid eye disease?
Common features include exophthalmos, conjunctival oedema, optic disc swelling, and ophthalmoplegia.
What can inability to close the eyelids lead to in thyroid eye disease?
Inability to close the eyelids may lead to sore, dry eyes and, if severe and untreated, exposure keratopathy.
What are the management strategies for thyroid eye disease?
Management includes smoking cessation, topical lubricants, steroids, radiotherapy, and surgery.
What is the most common complication of thyroid eye disease?
Exposure keratopathy is the most common complication.
What causes exposure keratopathy in thyroid eye disease?
It is due to eyelid retraction and proptosis, leading to excessive exposure of the cornea.
What symptoms are associated with exposure keratopathy?
Symptoms include foreign body sensation, pain, and photophobia.
What serious complication can arise from thyroid eye disease?
Optic neuropathy is one of the most serious complications.
What causes optic neuropathy in thyroid eye disease?
It occurs when enlarged extraocular muscles compress the optic nerve at the apex of the orbit.
What are the potential visual impairments caused by optic neuropathy?
It can lead to a reduction in visual acuity, colour vision deficits, and visual field defects.
What can result from fibrosis and enlargement of extraocular muscles in thyroid eye disease?
It can result in restrictive strabismus and double vision (diplopia).
What are the signs that indicate the need for urgent review by an ophthalmologist in established thyroid eye disease?
Signs include unexplained deterioration in vision, change in colour vision, globe subluxation, obvious corneal opacity, and disc swelling.
