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THYROID ((Hormone profile (Diagnosis), ↑tsh, ↓t4 (Hypothyroidism), ↑tsh,…

- - - - Eye discomfort, grittiness, ↑tear production, photophobia, diplopia, ↓acuity, afferent pupillary defect may mean optic nerve compression: Seek expert advice at once as decompression may be needed. Nerve damage does not necessarily go hand-in-hand with protrusion. Indeed, if the eye cannot protrude for anatomical reasons, optic nerve compression is more likely—a paradox!
    - - Exophthalmos—appearance of protruding eye; proptosis—eyes protrude beyond the orbit (look from above in the same plane as the forehead); conjunctival oedema; corneal ulceration; papilloedema; loss of colour vision. Ophthalmoplegia (especially of upward gaze) occurs due to muscle swelling and fibrosis.
    - - Diagnosis is clinical. ct/mri of the orbits may reveal enlarged eye muscles.
    - - Get specialist help. Treat hyper- or hypothyroidism.
        Advise to stop smoking (worse prognosis).
        Most have mild disease that can be treated symptomatically (artificial tears, sunglasses, avoid dust, elevate bed when sleeping to ↓periorbital oedema).
        Diplopia may be managed with a Fresnel prism stuck to one lens of a spectacle (aids easy changing as the exophthalmos changes).
        In more severe disease, try high-dose steroids (iv methylprednisolone is better than prednisolone 100mg/day po)18—decreasing according to symptoms.
        Surgical decompression is used for severe sight-threatening disease, or for cosmetic reasons once the activity of eye disease has reduced (via an inferior orbital approach, using space in the ethmoidal, sphenoidal, and maxillary sinuses).
        Eyelid surgery may improve cosmesis and function. Orbital radiotherapy can be used to treat ophthalmoplegia but has little effect on proptosis.
    - - Anti-tnfα‎ antibodies (eg infliximab).
  - - - Typical age: 40–60yrs (younger if maternal family history).
      - circulating igg autoantibodies binding to and activating g-protein-coupled thyrotropin receptors, which cause smooth thyroid enlargement and ↑hormone production (esp. t3), and react with orbital autoantigens.
      - Triggers: stress; infection; childbirth. Patients are often hyperthyroid but may be, or become, hypo- or euthyroid. It is associated with other autoimmune diseases: vitiligo, type 1 dm, Addison’s