533 - D- Ocular Disease, Thyroid Eye Disease

Front 1

true or falseEvery cell in the body depends upon thyroid hormones for regulation of their metabolism?

Back 1

true

Front 2

what percentage of each of T4 and T3 does the thyroid gland produce?

Back 2

80% T4 and 20% T3

Front 3

which is more powerful T4 or T3?

Back 3

T3 4X more powerful

Front 4

the hypothalamus produces____and the pituitary produces____ which stimulates the thyroid gland.

Back 4

TSH releasing hormone and thyroid stimulating hormone.

Front 5

What are the two major causes of hypothyroid

Back 5

1. inflammation
2. The broad category of “medical treatments”

Front 6

Inflammation is one of the most common causes of hypothyroid. what is the most common cause of inflammation in this manner?

Back 6

autoimmune thyroiditis (hashimotos disease).

Front 7

true or false and explain. a goiter only occurs in hyothyroidism.

Back 7

false it most often occurs in hypothyroid b/c it is trying to make more T4 and T3. but can be seen in hyperthyroid also.

Front 8

Most common underlying cause of hyperthyroidism is

Back 8

Graves' disease

Front 9

How can an autoimmune dz be responsible for hyperthyroid?

Back 9

Antibodies, that the patient's immune system makes, attach to specific activating sites on a thyroid gland which causes the thyroid to make more hormone

Front 10

There are actually three distinct parts of Graves' disease: what are they?

Back 10

[1] over activity of the thyroid gland (hyperthyroidism),
[2] thickening of the skin over the lower legs (pretibial myxedema), and
[3] inflammation of the tissues around the eyes causing swelling

Front 11

Ophthalmic Graves disease (euthyroid condition) is when?

Back 11

When the eye signs of Graves' disease occur in a patient who is not clinically hyperthyroid

Front 12

Thyroid eye disease affects women or men more?

Back 12

women 8:1 to men

Front 13

Thyrotoxicosis is another name for?

Back 13

hyperthyroidism

Front 14

Risk Factors for thyroid eye disease

Back 14

smoking, radioiodine, and gender.

Front 15

Three classifications systems for graves dz are?

Back 15

NOSPECS (pneumonic)
Clinical Activity Score (CAS)
By structure

Front 16

NOSPECS' usage is limited b/c?

Back 16

it lacks a means of measuring the rate of progression or treatment induced regression.

Front 17

Class 0 -the N in NOSPECS means what?

Back 17

No signs or symptoms
Management: Routine physical and eye exams

Front 18

Class 1 – O. in NOSPECS means what?

Back 18

Only signs, no symptoms (non-infiltrative stage)
Upper lid "lag" on down gaze (von Graefe sign)
Stare (Kocher's sign)

Front 19

Management of Class one signs.

Back 19

Lubrication
Medication-Topical alpha adrenergic blockers – relaxes muscles-Dapiprazole
Topical beta adrenergic blockers-Propranolol
lastly surgery.

Front 20

Class 2 -S in NOSPECS what is it?

Back 20

Soft tissue involvement (1st stage of infiltrative ophthalmopathy)

Front 21

symptoms of class 2 S- of NOSPECS

Back 21

Symptoms
Lacrimation
Photophobia
FB sensation
Retrobulbar discomfort

Front 22

signs of class 2 S- of NOSPECS

Back 22

Signs
Lid and conjunctival edema
Lid and conjunctival hyperemia (redness)
Conjunctival chemosis (edema of the conj)
Extrusion of orbital fat
Lacrimal gland swelling
Inflammation near EOM insertion

Front 23

Management of class 2- S of NOSPECS

Back 23

Lubrication
Elevate head during sleep
Tinted cosmetic lenses
Steroids (systemic and periocular)

Front 24

class 3 P In NOSPECS what is it/

Back 24

Proptosis (exophthalmos) Hyperthyroidism is most common cause of unilateral proptosis

Front 25

80% of those patients with bilateral exophthalmos will have

Back 25

Graves' disease

Front 26

Management of class 3- P in NOSPECS

Back 26

Management - may be permanent and require no TX
Lubrication
Lid taping
Steroids
Tarsorrhaphy (stitching)

Front 27

Class 4 - E in NOSPECS what is it

Back 27

EOM involvement.

Front 28

Palsy or diplopia is commmon in class?

Back 28

class 4.

Front 29

which two muscles are most commonly affected by graves dz

Back 29

IR 60-70% of the time followed by MR.

Front 30

management of class 4 problems?

Back 30

Lubrication
Eye patching or prisms
Meds Steroids botulinum toxin
Surgery - wait 6 months to 1 year

Front 31

Class 5 - C in NOSPECS is what? give an example

Back 31

Corneal involvement
Exposure keratopathy (can pose serious threat to vision)

Front 32

Management fo class 5 C in nospecs.

Back 32

Lubrication
Meds-Antibiotics,Steroids
Orbital radiation
Orbital decompression

Front 33

class 6 S in NOSPECS is what?

Back 33

Sight loss (ON involvement)

Front 34

signs associated with class 6 S in NOSPECS

Back 34

Optic disc edema
Painless, gradual loss of vision

Front 35

management of class 6 S of NOSPECS.

Back 35

Correction of thyroid imbalance
Meds-Steroids,Cytotoxic or immunosuppressive agents
Orbital radiation
Orbital decompression

Front 36

b/c of criticism regarding teh NOSPECS pneumonic a new system was proposed called the?

Back 36

CAS clinical activity score.

Front 37

how does the CAS system work?

Back 37

one point is given for each condition found on the pt from a given list. when all of the scores are added up to get a predictive value for therapeutic outcome.

Front 38

enlarged ocular muscles due to graves dz is due to what?

Back 38

accumulations of glycoproteins, lymphocytes and fibrosis.

Front 39

what can the enlargement of EOMs cause?

Back 39

pressure on the optic nerve, and reduced eye movements.

Front 40

treatment for thyroid dysfunction may include?

Back 40

Meds
PTU (propylthiouracil)
MMI (methimazole)
Thyroidectomy
Ocular lubricants
Systemic steroids for severe corneal damage
Surgical decompression
Surgical tx of EOM abnormalities