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Y. neuro ophthalmology > Thyroid Eye Disease > Flashcards

Thyroid Eye Disease Flashcards

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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

Study These Flashcards
A
  1. Tumor (esp Lymphoma)
  2. Infectious (Preseptal or Orbital)
  3. Dural Sinus Fistula
  4. Metastasis
  5. IOIS
25
DDx for TED in children (3)
1. Congenital 2. Infectious (Preseptal or Orbital) 3. Malignancies (rhadbomyosarcoma**, neuroblastoma, Ewing’s, and retinoblastoma)
26
NOSPECS classification
No physical symptoms Only signs (no symptoms) Soft tissue involvement Proptosis EOM involvement Corneal involvement Sight loss
27
Describe the early stage of TED
Non-specific inflammatory signs/symptoms
28
Describe the inactive stage of TED
1. Lid abnormalities (retraction, edema, lagophthalmos) 2. Diplopia/vision loss
29
Vision loss associated with TED is usually due to (2)
Optic neuropathy or corneal involvement
30
Is suspecting TED, but pt c/o pain, the diagnosis is more likely…
1. IOIS 2. Infections 3. Tumor
31
TED onset is typically ___ (gradual/sudden)
Gradual
32
What are the limitations of the NOSPECS classification system?
Does not distinguish inflammatory progression from non-inflammatory progression
33
___ is one of the most popular classification methods for TED today
Clinical Activity Score (CAS)
34
Why was the CAS system formed?
To discriminate easily between active and quiescent stages of TED
35
What CAS score is indicative of **active** TED?
Above 3/7 on initial visit or 4/10 on successive visits
36
What are the main systems graded by the VISA?
Vision Inflammatory Strabismus Appearance/Exposure
37
What inflammatory score on the VISA scale warrants ‘aggressive’ therapy?
5/10
38
What is the main benefit of EUGOGO?
Picture atlas for comparison
39
Studies show that ____% of orbitipathy pts improve, ___% remain stable, and ___% worsen
50% improve 35% remain stable 15% worsen
40
General “First Step” Treatments for TED
Diamox (CAI) Artificial Tears Tape Lids at night Elevate Head Prism Avoid pre-op iodine Gazing in all directions Educate patient Steroid injections
41
Treatment for *mild* TED?
“General first steps” + oral selenium (100 µg 2x/day)
42
Benefits of selenium
Improves quality of life, reduces ocular involvement, and slows progression of TED
43
Which delivery method proved to have a highest response rate?
IV (82%) vs oral (53.4%)
44
What are benefits of IV steroids?
1. Higher response 2. Fewer side effects 3. Shorter tx time 4. Lower relapse rate
45
Cumulative dose of steroids should not exceed…
8g
46
Commonly used steroid regimen for **moderate** TED
500 mg methylprednisolone x 6 wk Then, 250 mg x 6 weeks
47
CI for steroid treatment of TED
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
Management for *moderate* TED
Steroids + Orbital radiotherapy
49
Management of **Sight-Threatening** TED
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
Selenium can be found in… (food)
Meat, fish, eggs, cereals…
51
What is the general mechanism for selenium that improves TED
Involved in cellular redox state —> has antioxidant and immunomodulatory effects
52
Most feared complication of TED?
Optic neuropathy
53
T/F: vision loss can be reversed with TED
TRUE; medial and lateral decompression highly successful in reversing VL
54
Common VF defects with ON neuropathy (4)
1. Enlarged blind spots 2. Nerve fiber defects 3. Central or cecocentral defects 4. General constriction
55
T/F: only a small percentage of TED pts experience vision loss
TRUE (2-9%)
56
TED f/u’s should include:
1. VF 2. Color vision (monocular) 3. Contrast sensitivity 4. VEP 5. R/o pallor, swelling, and hyperemia 6. Assess for MG
57
Long-standing muscular edema along with increased production of collagen leads to…
1. Atrophy 2. Fibrosis 3. Sclerosis (of EOM) 4. Restrictive strab
58
F/U’s for TED should occur every ____
1-3 months

Y. neuro ophthalmology (10 decks)

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