Thyroid Eye Disease Flashcards
True or false: thyroid eye disease affects more men than women
False; it affects more women than men.
Thyroid eye disease generally develops in what age range?
20-45 years
What is the major clinical risk factor for developing thyroid eye disease?
Smoking
True or false: thyroid ophthalmopathy can occur without any evidence of thyroid dysfunction
True; this actually occurs in 10-25% of cases.
What are the four ways to classify thyroid eye disease?
By structure, NOSPECS, clinical activity score (CAS), and VISA
Name the sign: puffy lids.
Enroth’s sign
Name the sign: lid retraction.
Dalymple’s sign
Name the sign: delay of the upper lid in following globe movement in downward gaze.
Von Graefe’s sign
Name the sign: jerky downward movement of the lid
Boston’s sign
Name the sign: delay of the lower lid in following globe movement in upward gaze.
Griffith’s sign
Name the sign: globe lagging behind upper lid on upward gaze.
Kocher’s sign
Name the sign: tremor of closed eyelids.
Rosenbach’s sign
Name the sign: reduced blinking.
Stellwag’s sign
Name the sign: increased pigmentation of eyelid skin
Jellinek’s sign
In managing thyroid eye disease, what are some therapies you can use to help with the lid signs?
Lubrication (for cornea), topical alpha blockers (to relax muscles), beta blockers (relief of signs of thyrotoxicosis), botulinum toxin
True or false: with proptosis, you can hear a bruit through the patient’s closed eyelid
True.
EOM activity can be reduced with thyroid eye disease. Which EOMs are most affected, and what is the result? Are there any other signs from the EOMs?
IR is most commonly affected (diplopia on upgaze) and MR. IOP can raise on upgaze due to traction on the globe.
What is the most common cause of unilateral proptosis?
Hyperthyroidism
True or false: most patients with bilateral exophthalmos have Graves’ disease
True.
In thyroid eye disease, the swelling of the EOMs can put pressure on the optic nerve, potentially causing loss of vision. Do many patients recover their sight?
70% of patients improve without treatment!
What is NOSPECS and what does it stand for?
It’s a way to classify the severity of involvement. Generally, each class has the involvements of the previous classes:
No physical signs or symptoms (Class 0)
Only signs, no symptoms (i.e. upper lid retraction, stare, eyelid lag) (Class 1)
Soft tissue involvement (symptoms and signs) (Class 2)
Proptosis (Class 3)
EOM involvement (Class 4)
Corneal involvement (Class 5)
Sight loss (Class 6)
What might you see in a Class 1 patient, according to NOSPECS?
Signs such as Darylmple’s or Von Graefe’s
What might you see in a Class 2 patient, according to NOSPECS?
Lacrimal, photophobia, FB sensation, retrobulbar discomfort, lid/conjunctival edema/hyperemia, conjunctival chemosis, extrusion of orbital fat, lacrimal gland sweeling, inflammation near EOM insertion
What might you see in a Class 3 patient, according to NOSPECS?
Proptosis
