Graves disease commonly presents in a 40yearold african american woman who presents with general symptoms of hyperthyroidism, a diffusely enlarged thyroid, and exophthalmos. Exophthalmos in autoimmune thyroid disease the journal of. The classic clinical triad of graves disease involves a diffuse vascular goiter, ophthalmopathy, and pretibial myxedema, although. Ultimately, the hyperthyroidism manifested by patients affected by the disease is caused by the production of autoantibodies against the thyrotropin receptor tshr, which mimic the effects of the hormone on thyroid cells, thereby stimulating autonomous production of thyroxine and triiodothyronine. In italo svevos novel zenos conscience, character ada develops the disease. It frequently results in and is the most common cause of hyperthyroidism. The defining characteristic of this condition is the protrusion of the eyes exophthalmos. Treatment for bulging eyes exophthalmos depends on what is causing the problem. The etiological basis of proptosis can include inflammatory, vascular, infectious, cystic, neoplastic both benign and malignant, metastatic disease, and traumatic factors. Exophthalmos definition of exophthalmos by the free dictionary. Graves ophthalmopathy, also known as thyroid eye disease ted, is an autoimmune inflammatory disorder of the orbit and periorbital tissues, characterized by upper eyelid retraction, lid lag, swelling, redness, conjunctivitis, and bulging eyes exophthalmos. The two chief manifestations of the disorder are exophthalmos and hyperplastic goiter with hyperthyroidism. Graves ophthalmopathy go, an autoimmune condition associated with graves disease gd, occurs at a prevalence of nearly 40% in patients diagnosed with gd. Exophthalmos also called exophthalmus, exophthalmia, proptosis, or exorbitism is a bulging of the eye anteriorly out of the orbit.
Most commonly affects middle aged women with female to male ratio of 4. Exophthalmos is obvious when it is advanced enough to cause complications. Graves ophthalmopathy in relation to cigarette smoking and ethnic origin. In contrast, exophthalmos from orbital tumors or a blood clot in the brain happens on only one side. The exophthalmos of hyperthyroidism american journal of.
In rare cases, exophthalmos may be caused by other diseases. It occurs most commonly in individuals with graves disease, and less commonly in individuals with hashimotos thyroiditis, or in. Diagnostic pathology and molecular genetics of the thyroid 2nd ed. Graves disease is essentially an autoimmune disease in which autoantibodies are developed to the membrane receptor for tsh tshreceptor present on thyroid follicular epithelial cells.
Graves disease hyperthyroidism explained made easy this video tutorial is brought to you by. In graves disease, elevated levels of antitopoisomerase antibodies and antithyroglobulin antibodies are found in 80% and 50% of cases, respectively mod pathol 2000. It is almost always associated with graves disease gd but may rarely be seen in hashimotos thyroiditis, primary hypothyroidism, or thyroid cancer. Pseudoproptosis refers to the false impression of proptosis caused by. Proptosis, or a prominent globe, can be a manifestation of thyroid abnormalities, especially graves disease chapter 233, in which proptosis is subacute and bilateral but sometimes asymmetrical fig. Hyperthyroidism during childhood is usually caused by graves disease. Mechanisms of graves disease and endocrine exophthalmos. Graves disease is an autoimmune condition of the thyroid. Graves orbitopathy is an autoimmune disease of the retroocular tissues occurring in patients with graves disease. Apart from the transient neonatal cases that develop in infants born to mothers with active graves disease, the disease occurs infrequently in preschool children and rarely may begin in infancy. The most common orbital disease usually with exophthalmos is graves orbitopathy, which is the extrathyroidal complication of graves thyroid disease. Graves disease knowledge for medical students and physicians. N2 graves disease has been recorded in the medical literature for more than 150 years.
Graves disease usually develops in people younger than 40. They may recommend regular examinations to monitor your condition. Graves disease is a disease of autoimmunity, but the final cause of autoimmunity remains unclear. Choose from 180 different sets of graves disease flashcards on quizlet. Hyperthyroidism can cause exophthalmos how can it be prevented. In graves disease, b and t lymphocytemediated autoimmunity are known to be directed at 4 wellknown thyroid antigens. Graves disease, also known as toxic diffuse goiter, is an autoimmune disease that affects the. Chapter 11diagnosis and treatment of graves disease. Prevalence of graves ophthalmopathy in patients with graves disease presenting to a referral centre in north india. Graves disease, a common form of hyperthyroidism characterized by a goiter and often a slight protrusion of the eyeballs, currently affects approximately 200 million people worldwide, three million in the united states alone. The causes of proptosis are broad and include a wide range of mass lesions that originate within the cranium, sinuses, paranasal spaces, and orbit 3. The annual incidence rate of graves orbitopathy has been estimated at 16 cases per 100,000 women and 2. Graves disease hyperthyroidism everything you need to. T1 surgical correction of exophthalmos secondary to graves disease.
Signs and symptoms of hyperthyroidism may include irritability, muscle weakness, sleeping problems, a fast heartbeat, poor tolerance of heat, diarrhea and unintentional. Mar 19, 2020 the underlying cause of graves disease is not known, but there is genetic susceptibility to the disease, and smoking is a risk factor, especially for graves ophthalmopathy. Graves disease patient with exophthalmos and vitiligo. Structural biochemistrygraves disease wikibooks, open.
While ted is most commonly associated with graves disease, it can also occur in association with other. The chronic progressive exophthalmos of the type seen in graves disease, even when uncomplicated, is obviously a highly complex phenomenon, perhaps as complex etiologically as graves disease. Graves disease, basedows disease, exophthalmic goiter, graves disease, graves dermopathy. It is a disorder that affects mainly females, and although it may occur at any age, has a peak incidence in the 3rd and 4th decades. It can affect 1 or both eyes and is most often caused by thyroid eye disease. As a result, the thyroid gland enlarges and secrets increased amounts of thyroid hormones. Graves disease gd is an autoimmune disorder responsible for 6090% of thyrotoxicosis, with an incidence of 1 to 2 cases per population per year in england. In some cases, in its initial stages, exophthalmos can only be detected using imaging techniques.
Understanding hyperthyroidism and graves disease youtube. The ocular manifestations of thyroid eye disease ted include soft tissue inflammation, eyelid retraction. Graves disease, also graves disease, is an autoimmune disease that leads to hyperthyroidism it is often misspelled graves disease. If you would like a large, unwatermarked image for your web page or. Graves disease and the manifestations of thyrotoxicosis endotext. You may not embed one of our images on your web page without a link back to our site.
Graves disease, also graves disease, is an autoimmune disease that leads to hyperthyroidism. Exophthalmos can be either bilateral as is often seen in graves disease or unilateral as is often seen in an orbital tumor. Graves disease is caused by thyroid stimulating immunoglobulin tsi, also known as thyroid stimulating antibody tsab. A differentiation in the mechanism, pathology, symptomatology, and treatment of two varieties part iii. An orbital pseudotumor can cause acute, usually unilateral proptosis, with severe pain, particularly with eye movement, and often with decreased vision. Such an approach would also require the development of novel clinical and. T1 mechanisms of graves disease and endocrine exophthalmos. The first and only consumer book on thyroid eye disease by the author of graves disease, a practical guide this second printing of elaine moores meticulous, exhaustive and thoughtful book, is the definitive guide on thyroid eye disease ted, more specifically referred to as graves ophthalmopathy go. Graves disease may be considered to be a thyroidpituitary syndrome.
This page includes the following topics and synonyms. Although it has often been referred to as graves ophthalmopathy, it is primarily a disease of the orbit and is better termed graves orbitopathy. Proptosis, the forward displacement of the globe, stems from this increase in orbital tissue. Graves disease also known as parrys or basedows disease is a complex disease whose pathogenesis is believed to be autoimmune. In patients severely ill with other disease, in elderly patients with apathetic hyperthyroidism, or when the presenting symptom is unusual, such as muscle weakness, or psychosis, the diagnosis depends on clinical alertness and laboratory tests. Indeed, graves disease is the most common cause 2030% of unilateral exophthalmos. Graves disease, also known as toxic diffuse goiter, is an autoimmune disease that affects the thyroid. One condition that can cause thyroid eye disease and, therefore, exophthalmos is graves disease. Exophthalmos definition of exophthalmos by medical dictionary. Women are much more likely to develop graves disease than are men. Graves ophthalmopathy imaging evaluation intechopen. As a result, graves disease is essentially a type ii hypersensitivity reaction.
The classic finding of exophthalmos and lid retraction in graves disease. Up to onehalf of people with graves disease develop eye symptoms. Choose from 18 different sets of exophthalmos flashcards on quizlet. The most common cause for unilateral or bilateral exophthalmos is thyroid eye disease, or graves ophthalmopathy. Exophthalmos, abnormal protrusion of one or both eyeballs. Graves disease is the most common cause of hyperthyroidism and often affects women. Another characteristic of the disease is spontaneous remission of hyperthyroidism, which occurs in 30 to 40 percent of patients. Graves disease associated with exophthalmos, cerebral. In cases of graves disease an appearance of exophthalmos may be produced bytwodifferent phenomena. Learn graves disease with free interactive flashcards. Learn exophthalmos with free interactive flashcards. Graves eye disease, also called graves ophthalmopathy, is a problem that develops in people with an overactive thyroid caused by graves disease. Graves disease may be associated with antitpo antibodies but it is caused by antithyrotropin tsh receptor autoantibody that mimic tsh and stimulate hormone synthesis, secretion and thyroid growth. Jul 22, 2014 exophthalmos may be accompanied by other signs.
We discuss some definitions around hyperthyroidism, the different causes, the. In graves disease the excessive secretion of thyroid hormone is accompanied by diffuse enlargement of the thyroid gland diffuse. One normal immune system response is the production of antibodies designed to target a specific virus, bacterium or other foreign substance. Graves disease is caused by a malfunction in the bodys diseasefighting immune system, although the exact reason why this happens is still unknown. The mean values for protrusion in patients with thyrotoxic graves. In graves disease, the main autoantigen is the thyroidstimulating hormone tsh receptor tshr, which is expressed primarily in the thyroid but also in adipocytes, fibroblasts, bone cells, and a variety of additional sites 4,5. Thyroid eye disease is an inflammatory condition which affects the orbital contents including the extraocular muscles and orbital fat. Exophthalmos from graves disease is bilateral occurring on both sides, but not necessarily symmetrical. It is an autoimmune condition that is associated with circulating tsh receptor autoantibodies leading to overstimulation of the thyroid with excess thyroid hormone production. Evaluation of exophthalmos and thyroid ophthalmopathy. Graves disease includes thyrotoxicosis, goiter, exophthalmos, and pretibial myxedema when fully expressed, but can occur with one or more of these features. The purpose of this retrospective followup study is to evaluate the prevalence of patients with thyroid eye disease presenting with apparent unilateral proptosis and determine the occurrence of exophthalmos in contralateral nonproptotic eye over the time.
When a thyroid condition causes symptoms that affect the eyes, it is known as a thyroid eye disease or thyroid orbitopathy. If you have exophthalmos, there is a small risk of your optic nerve which sends signals between your eye and brain becoming compressed, which may affect your sight. Exophthalmos, also known as proptosis, is the medical term for bulging or protruding eyeballs. Sometimes exophthalmos is the only manifestation of the disease. Other articles where graves ophthalmopathy is discussed. Graves disease may present clinically with one of the following characteristic signs.
A thorough physical examination is not sufficient to establish a specific diagnosis and its etiology. A cohort of 655 consecutive patients affected by thyroid eye disease with a minimum. Curiously, binding of autoantibodies to tshreceptor results in receptor activation in the absence of tsh. Definition csp, exophthalmos occurring in association with goiter.
Diagnostic imaging, especially computed tomography ct, is especially helpful in the study of orbital disease. Exophthalmos in a young woman with no graves disease a. Since the muscles and orbital cells become inflamed and the eye is pressed forwards, the optic nerve is placed under tension and the individual can become entirely blind in thyroid eye disease. Ocular involvement is probably due to the presence of autoantibodies in the orbital tissues, regardless of the control state of thyroid. Unilateral proptosis in thyroid eye disease with subsequent. Although it has often been referred to as graves ophthalmopathy, or simply thyroid eye disease ted, it is primarily a disease of the orbit and is better termed graves orbitopathy. Jan 27, 2014 graves disease is an autoimmune disease in which the patients own immune system attacks the thyroid gland, causing it to produce too much thyroxine. Thyroxine t4 is a hormone produced by the thyroid gland that has four iodine molecules attached to its molecular structure.
Discussion differential diagnosis ofthe causes of exophthalmos. Tumours such as glioma and meningioma of the optic nerve and cavernous haemangioma may also be responsible. Graves disease is an autoimmune disease in which the patients own immune system attacks the thyroid gland, causing it to produce too much thyroxine. Graves disease is the most common cause of hyperthyroidism, with an annual. Jan 22, 2020 exophthalmos is defined in dorlands medical dictionary as an. Usually the eye symptoms are mild and easily treated. Graves disease and the manifestations of thyrotoxicosis. Sep 27, 2014 graves disease hyperthyroidism explained made easy this video tutorial is brought to you by. Graves ophthalmopathy signs and symptoms include bulging eyes exophthalmos, redness and retracting eyelids. Epidemiology and prevention of graves ophthalmopathy. Associated features with this event were evaluated. Surgical correction of exophthalmos secondary to graves disease.
The proptosis arises from inflammation, cellular proliferation, and accumulation of fluid in the tissues that surround the. The eyelids may be retracted upward, making it seem as though the person is constantly staring. Graves disease includes thyrotoxicosis, goiter, exophthalmos, and. This video contains a detailed and simplified explanation about hyperthyroidism and graves disease. Because a family history of graves disease is a known risk factor, there is likely a gene or genes that can make a person more susceptible to the disorder. Ethnic factors and myopia affect proptosis but were not mentioned. Thyroid exophthalmos may appear months or years after the onset of a thyroid disorder but may occasionally precede it. An eye specialist ophthalmologist may sometimes advise you that immediate treatment is not necessary. Graves disease, also called toxic diffuse goitre or exophthalmic goitre, endocrine disorder that is the most common cause of hyperthyroidism excess secretion of thyroid hormone and thyrotoxicosis effects of excess thyroid hormone action in tissue. Exophthalmos is a condition that is often seen by ophthalmologists. Many of the patients had less than 3 mm of proptosis, or class 1, which is cosmetic or nonthreatening, but some had 3 mm or more, class 3. If you have thyroid eye disease, your treatment may be in several stages. Since a variety of other neuroophthalmic disorders require consideration when the unilateral proptosis or malposition of the eyelid are detected, including a retrobulbar tumors, myasthenia gravis, myositis, lymphoma, metastasis, arteriovenous. Started in 1995, this collection now contains 6769 interlinked topic pages divided into a tree of 31 specialty books and 732 chapters.
27 647 1123 1293 1560 1314 344 1086 1209 499 223 1022 1534 1514 1142 303 488 1561 716 1590 975 1513 1222 206 1174 1286 294 1434 361 1322 921 338 255 844 111 466