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Clin Med: 209 Graves

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)
Created by: LaurenLofdahl