Thyroid eye disease

Question 1

Pathophysiology

Answer 1

Autoimmune response against an autoantigen leading to retro-orbital inflammation

Results in glycosaminoglycan and collagen deposits in the muscles

Question 2

Most important modifiable risk factor

Answer 2

Smoking

Question 3

Prevention

Answer 3

Stop smoking

Radioiodine treatment may increase inflammatory symptoms

Prednisolone may help reduce the risk

Question 4

Features

Answer 4

Exopthalmos (bulging eyes)

Conjunctival oedema

Optic disc swelling

Opthalmoplegia

Dry/ sore eyes if unable to close

Question 5

Management

Answer 5

Topical lubricants to prevent corneal inflammation

Steroids

Radiotherapy

Surgery

Question 6

Need for urgent review

Answer 6

Unexplained deterioration in vision

Awareness of change in intensity of colour vision

History of eye suddenly ‘popping out’

Obvious corneal opacity

Cornea still visible when eyelids are closed

Disc swelling