Thyroid Eye Diseases

Question 1

Pathophysiology

Answer 1

• Autoimmune response against an autoantigen, possibly the TSH receptor -> retro-orbital inflammation
• Inflammation results in gylcosaminoglycan and collagen deposition in the muscles

Question 2

Risk factors

Answer 2

• Smoking
• Radioiodine treatment

Question 3

Features

Answer 3

• Exopthalmos
• Conjunctival oedema
• Optic disc swelling
• Ophthalmoplegia
• Inability to close the eyelids my lead to sore, dry eyes
• Exposure keratopathy

Question 4

Management

Answer 4

• Smoking cessation
• Topical lubricant may be needed to help prevent corneal inflammation caused by exposure
• Steroids = PREDNISOLONE
• Radiotherapy
• Surgery

Question 5

Complications

Answer 5

• Exposure keratopathy
• Optic neuropathy
• Strabismus and diplopia

Question 6

URGENT REVIEW

Answer 6

EUGOGO guidelines:
- unexplained deterioration in vision
- awareness of change in intensity or quality of colour vision in one or both eyes
- history of eye suddenly ‘popping out’ (globe subluxation)
- obvious corneal opacity
- cornea still visible when the eyelids are closed
- disc swelling