Thyroid Eye Disease (TED)

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Questions and Answers

What is the most common cause of both bilateral and unilateral proptosis in an adult?

  • Glaucoma
  • Thyroid eye disease (correct)
  • Cataracts
  • Retinal detachment

What is the major clinical risk factor for developing TED in patients with Graves disease?

  • Lack of physical exercise
  • Excessive caffeine intake
  • High cholesterol levels
  • Smoking (correct)

Who is more likely to be affected by TED?

  • Children
  • Elderly individuals
  • Women (correct)
  • Men

What can worsen TED in patients with hyperthyroidism?

<p>Radioactive iodine (D)</p> Signup and view all the answers

What is the initial treatment option for acute compressive optic neuropathy?

<p>Intravenous methylprednisolone (A)</p> Signup and view all the answers

Which treatment may be used in addition to steroids or when steroids are contraindicated or ineffective?

<p>Low-dose fractionated radiotherapy (B)</p> Signup and view all the answers

What is a potential adverse effect of the treatment for acute optic nerve compression?

<p>Cataract (C)</p> Signup and view all the answers

What combined therapy may be more effective than steroids or radiotherapy alone?

<p>Irradiation and azathioprine (A)</p> Signup and view all the answers

What is a potential consequence of orbital decompression?

<p>Improved ocular motility (C)</p> Signup and view all the answers

What is the most commonly indicated surgery for restrictive myopathy?

<p>Recession of the inferior and/or medial recti (B)</p> Signup and view all the answers

What may be used for mild lid retraction?

<p>Botulinum toxin injection to the levator aponeurosis and Müller muscle (D)</p> Signup and view all the answers

What is used for post-inflammatory complications in TED?

<p>Rituximab (A)</p> Signup and view all the answers

What percentage of TED patients develop long-term ocular problems?

<p>10% (B)</p> Signup and view all the answers

What is a symptom of soft tissue involvement in TED?

<p>Red eyes (A)</p> Signup and view all the answers

What can lid retraction in TED result in?

<p>Staring or bulging-eyed appearance (B)</p> Signup and view all the answers

What percentage of TED patients develop permanent ophthalmoplegia?

<p>30% (A)</p> Signup and view all the answers

What is a clinical feature of TED?

<p>Ptosis (A)</p> Signup and view all the answers

What is a complication of TED that can cause severe visual impairment?

<p>Optic neuropathy (D)</p> Signup and view all the answers

What is a part of the treatment for mild TED?

<p>Topical anti-inflammatory agents (B)</p> Signup and view all the answers

What is an investigation for TED patients to check for optic nerve compromise?

<p>Visual field testing (C)</p> Signup and view all the answers

What is a consequence of proptosis in TED?

<p>Exposure keratopathy (C)</p> Signup and view all the answers

What is a stage that TED proceeds through?

<p>Congestive (D)</p> Signup and view all the answers

What should be managed as part of TED treatment?

<p>Thyroid dysfunction (B)</p> Signup and view all the answers

What is a feature of moderate to severe active TED disease treatment?

<p>Systemic steroids (C)</p> Signup and view all the answers

TED is not a common orbital disorder and rarely causes proptosis in adults.

<p>False (B)</p> Signup and view all the answers

Smoking is a major clinical risk factor for developing TED in patients with Graves disease.

<p>True (A)</p> Signup and view all the answers

Women are less likely to be affected by TED than men.

<p>False (B)</p> Signup and view all the answers

Thyroid ophthalmopathy involves an autoimmune reaction that leads to inflammation of extraocular muscles, orbital fat, and lacrimal glands.

<p>True (A)</p> Signup and view all the answers

Oral prednisolone is the first-line treatment for acute compressive optic neuropathy in TED.

<p>False (B)</p> Signup and view all the answers

Low-dose fractionated radiotherapy is used as the sole treatment for acute optic nerve compression.

<p>False (B)</p> Signup and view all the answers

Around 60% of patients with TED do not respond to treatment.

<p>False (B)</p> Signup and view all the answers

Orbital wall decompression may be considered if steroids are ineffective or contraindicated in TED.

<p>True (A)</p> Signup and view all the answers

Orbital radiotherapy is generally used as the sole treatment modality in TED.

<p>False (B)</p> Signup and view all the answers

Eyelid surgery should be performed before any necessary orbital and then strabismus procedures in TED.

<p>False (B)</p> Signup and view all the answers

Surgical decompression for proptosis in TED involves increasing the volume of the orbit by adding bony walls.

<p>False (B)</p> Signup and view all the answers

Botulinum toxin injection to the levator aponeurosis and Müller muscle is ineffective for mild lid retraction in TED.

<p>False (B)</p> Signup and view all the answers

Thyroid Eye Disease progresses through congestive and fibrotic stages, with 90% of patients developing long-term ocular problems.

<p>False (B)</p> Signup and view all the answers

Lid retraction occurs in about 50% of TED patients.

<p>True (A)</p> Signup and view all the answers

Proptosis in TED can lead to exposure keratopathy and corneal ulceration.

<p>True (A)</p> Signup and view all the answers

Between 30% and 50% of TED patients develop permanent ophthalmoplegia.

<p>True (A)</p> Signup and view all the answers

Optic neuropathy is not a serious complication of TED and does not cause severe visual impairment.

<p>False (B)</p> Signup and view all the answers

Investigations for TED include blood tests for thyroid disease and visual field testing for optic nerve compromise.

<p>True (A)</p> Signup and view all the answers

Mild TED treatment includes cessation of smoking, management of thyroid dysfunction, and use of lubricants, topical anti-inflammatory agents, and systemic steroids.

<p>False (B)</p> Signup and view all the answers

Moderate to severe active TED disease is not treated with systemic steroids.

<p>False (B)</p> Signup and view all the answers

Soft tissue involvement in TED presents with symptoms like red eyes, lacrimation, and signs such as epibulbar hyperemia and tear insufficiency.

<p>True (A)</p> Signup and view all the answers

Restrictive myopathy in TED is caused by subsequent degeneration of muscle fibers leading to fibrosis.

<p>True (A)</p> Signup and view all the answers

TED patients do not develop long-term ocular problems.

<p>False (B)</p> Signup and view all the answers

Thyroid Eye Disease does not proceed through congestive and fibrotic stages.

<p>False (B)</p> Signup and view all the answers

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Study Notes

Thyroid Eye Disease: Clinical Features and Treatment

  • Subsequent degeneration of muscle fibers leads to fibrosis, causing restrictive myopathy and diplopia.
  • TED proceeds through congestive and fibrotic stages, with only 10% of patients developing long-term ocular problems.
  • Clinical features include soft tissue involvement, lid retraction, proptosis, optic neuropathy, and restrictive myopathy.
  • Soft tissue involvement presents with symptoms like red eyes, lacrimation, and signs such as epibulbar hyperemia and tear insufficiency.
  • Lid retraction occurs in about 50% of patients and can result in a staring or bulging-eyed appearance.
  • Proptosis can lead to exposure keratopathy and corneal ulceration.
  • Between 30% and 50% of TED patients develop permanent ophthalmoplegia.
  • Optic neuropathy, a serious complication, can cause severe visual impairment.
  • Investigations include blood tests for thyroid disease and visual field testing for optic nerve compromise.
  • Treatment includes cessation of smoking, management of thyroid dysfunction, and use of lubricants, topical anti-inflammatory agents, and systemic steroids.
  • Mild disease treatment includes lubricants and topical anti-inflammatory agents.
  • Moderate to severe active disease is treated with systemic steroids.

Thyroid Eye Disease: Clinical Features and Treatment

  • Subsequent degeneration of muscle fibers leads to fibrosis, causing restrictive myopathy and diplopia.
  • TED proceeds through congestive and fibrotic stages, with only 10% of patients developing long-term ocular problems.
  • Clinical features include soft tissue involvement, lid retraction, proptosis, optic neuropathy, and restrictive myopathy.
  • Soft tissue involvement presents with symptoms like red eyes, lacrimation, and signs such as epibulbar hyperemia and tear insufficiency.
  • Lid retraction occurs in about 50% of patients and can result in a staring or bulging-eyed appearance.
  • Proptosis can lead to exposure keratopathy and corneal ulceration.
  • Between 30% and 50% of TED patients develop permanent ophthalmoplegia.
  • Optic neuropathy, a serious complication, can cause severe visual impairment.
  • Investigations include blood tests for thyroid disease and visual field testing for optic nerve compromise.
  • Treatment includes cessation of smoking, management of thyroid dysfunction, and use of lubricants, topical anti-inflammatory agents, and systemic steroids.
  • Mild disease treatment includes lubricants and topical anti-inflammatory agents.
  • Moderate to severe active disease is treated with systemic steroids.

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