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Clin Med: 209 Graves
Question | Answer |
---|---|
Butterfly shaped and largest of the endocrine glands. Located on either side of trachea. Releases hormones into circulation for normal growth/development | Thyroid gland |
Systemic effects of T3/T4 | cellular metabolic rxns, growth, contractibility of myocardial proteins, nervous system/endocrine gland/RBS function, GI motility |
Triad of Grave's Disease | 1. hyperthyroidism with goiter, 2. infiltrative dermatopathy, 3. infiltrative ophthalmopathy |
Hypersensitivity reaction with thyroid stimulation by the circulation of abnormal thyroid stimulating immunoglobulins | Grave's Disease |
Mechanism of Grave's Disease | Thyroid receptor antibodies attach to the thyroid follicular cells and cause increased production and release T3/T4 |
What percentage of Grave's Disease pts have ocular involvement? | 25-50% |
Why do patients with Grave's have hand tremors? | Over-action of the sympathetic system. May be treated with systemic beta-blockers |
Laboratory testing for Grave's | Serum T4, Serum T3, Antithyroid antibodies, Sensitive serum TSH test |
Systemic Management of Graves | Try medications first, Radioactive Iodine and supplement with Synthroid |
Single most common cause of all bilateral and unilateral proptosis | Graves Orbitopathy |
Proptosis measurements | 21-23(minimal) 24-27 (moderate) 28 or more = marked. 2mm difference b/w eyes is significant |
Possible mechanisms for eyelid retraction | direct inflammation of levator, hyperactivity of Mueller's, secondary over-action of levator/superior rectus in response to tethering of inferior rectus |
Infrequent blinking with Graves can cause... | Superficial limbal keratoconjunctivitis |
What is the reason for decreased VA in Grave's? | Compressive optic neuropathy due to thickened EOMS at orbital apex. Causes APD. |
What is one way to measure IOP with a Grave's pt? | IOP in upward gaze. (4mm elevation) |
Treatment for proptosis | Prednisone 100 mg PO qd x 1-2 days, oral decompression surgery |
Treatment for corneal ulcer | antibiotic ointment, antibiotic drop, bandage CL, consider tarsorrhaphy |
Treating double vision in inflamed eye (Grave's) | Prednisone 40-80mg daily, wait 6 mos to use prisms, Botox (wears off 3-4 mos), EOM surgery after 6 mos of stable condition |
Treatment of optic neuropathy | Prednisone 60-100mg PO qd with taper, radiation therapy, orbital decompression |
Removal of orbital floor and medial wall of orbital cavity. Increases reisk of orbital cellulitis. | Orbital decompression |
Class I Graves Disease includes... | Lid Involvement (retraction, lag, lagophthalmos) |
Lid retraction is present in ___% of Graves pts | 90% |
Class II Graves Disease includes... | Soft Tissue Involvement (conjunctiva, chemosis, periorbital edema) |
What is often the first sign of thyroid eye disease? | Periorbital edema caused by inflammation of subcutaneous connective tissue. Greatest in the morning |
Class III Graves Disease includes... | Infiltrative Orbitopathy and Exopthalmos |
Exophthalmos is permanent in __% of cases | 70% |
Class IV Graves Disease includes... | Restrictive Myopathy secondary to edema/fibrosis of EOMs |
Class V Graves Disease includes... | Corneal exposure and SLK |
What is a prognostic marker for severe Grave's ophthalmopathy? | SLK |
Class VI Graves Disease includes... | Optic Neuropathy (5-10% of pts) |
NOSPECS grading system for Graves | No symptoms (0), Only signs (1), Soft tissue (2), Proptosis (3), EOM (4), Cornea (5), Signt loss (6) |