Thyroid eye disease

Question 1

Thyroid eye disease is due to progressive inflammation of the fat, muscle and connective tissue around the eyes. Which condition is it by?

1 - additions disease
2 - graves disease
3 - cushings syndrome
4 - hashimoto disease

Answer 1

2 - graves disease

Also referred to as Graves ophthalmopathy

Question 2

What is the incidence of thyroid eye disease?

1 - 1 cases per 100,000
2 - 10 cases per 100,000
3 - 100 cases per 100,000
4 - 1000 cases per 100,000

Answer 2

2 - 10 cases per 100,000

Question 3

What age does the the incidence of thyroid eye disease typically peak?

1 - 20-30
2 - 30-40
3 - 40-50
4 - 50-60

Answer 3

2 - 30-40

Question 4

Is thyroid eye disease more common in men or women?

Answer 4

• women

6:1 ratio

Men have worse symptoms though

Question 5

Which of the following is NOT a risk factor for thyroid eye disease?

1 - male gender
2 - smoking
3 - genetics
4 - autoimmune diseases
5 - radioiodine treatment

Answer 5

1 - male gender

Radioiodine treatment can increase disease severity

Question 6

In thyroid eye disease thyroid stimulating immunoglobulins bind to tissues in the eye causing all of the following, EXCEPT which one?

1 - muscles
2 - fat
3 - retina
4 - connective tissues

Answer 6

3 - retina

The eye has a immune-privilege

Question 7

Patients with thyroid eye disease also have an increased expression of which growth factor present in the eyes?

1 - insulin like growth factor 1
2 - vascular endothelial growth factor
3 - epidermal growth factor
4 - platelet-derived growth factor

Answer 7

1 - insulin like growth factor 1

Question 8

Patients with thyroid eye disease also have an increased expression of insulin like growth factor 1 receptors. Auto-antiobodies bind to these receptors, which can lead to all of the following, EXCEPT which one?

1 - increase collagen production around the eye
2 - reduced fibrosis
3 - compressions of blood vessels, nerves and the eye
4 - all of the above

Answer 8

2 - reduced fibrosis

Excess collagen causes fibrosis and scar tissue in the eye

Extraocular muscles especially are affected

Glycosaminoglycans are also deposited in tissues

Question 9

There are 2 phases of thyroid eye disease: active and inactive phase. How long does the active phase, where there is inflammation swelling and damage?

1 - 6-12 weeks
2 - 1 year
3 - 6 months - 2 years
4 - lifetime

Answer 9

3 - 6 months - 2 years

Question 10

There are 2 phases of thyroid eye disease: active and inactive phase. In the inactive phase the disease progression stops. Does that mean that the tissue damage and symptoms will return to normal?

Answer 10

• no

The tissue damage and symptoms remain

Question 11

Due to the excessive collagen deposits around the eyes, do the eyes of patients with thyroid disease typically protrude forward forwards or backwards?

Answer 11

• forwards

Called exophthalmos, looks like intense staring

Question 12

In thyroid eye disease, which of the following eye symptoms can be present?

1 - dry, gritty feeling
2 - excessively watery
3 - sclera appears red and inflamed
4 - all of the above

Answer 12

4 - all of the above

Question 13

Does the excessive collagen deposits around the eyes in thyroid disease typically affect the eyelids?

Answer 13

• yes

Called lid retraction due to swelling, inflammation and difficulty to close

Patient may be unable to close them or be in pain when blinking

Question 14

Lid retraction in thyroid eye disease can mean that patients are unable to close the eyes. Which of the following can this lead to?

1 - ulceration
2 - scleritis
3 - exposure keratopathy
4 - blepharitis

Answer 14

3 - exposure keratopathy

excessive drying of the cornea

Question 15

Can thyroid eye disease affect vision itself?

Answer 15

• yes

Can cause blurry and double vision and photophobia

Question 16

Can thyroid eye disease lead to vision loss?

Answer 16

• yes in severe cases
• excessive collagen may compress and damage the optic nerve
• can cause dry eye and lead to erosion of the cornea

Question 17

Which of the following are treatment options for patients with thyroid eye disease?

1 - steroids
2 - topical lubricants
3 - radiotherapy
4 - surgery
5 - all of the above

Answer 17

5 - all of the above