Thyroid eye disease (NORD)

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Thyroid eye disease (NORD)

Endocrine system

Adrenal gland disorders

Congenital adrenal hyperplasia

Primary adrenal insufficiency

Waterhouse-Friderichsen syndrome

Hyperaldosteronism

Adrenal cortical carcinoma

Cushing syndrome

Conn syndrome

Thyroid gland disorders

Thyroglossal duct cyst

Hyperthyroidism

Graves disease

Thyroid eye disease (NORD)

Toxic multinodular goiter

Thyroid storm

Hypothyroidism

Euthyroid sick syndrome

Hashimoto thyroiditis

Subacute granulomatous thyroiditis

Riedel thyroiditis

Postpartum thyroiditis

Thyroid cancer

Parathyroid gland disorders

Hyperparathyroidism

Hypoparathyroidism

Hypercalcemia

Hypocalcemia

Pancreatic disorders

Diabetes mellitus

Diabetic retinopathy

Diabetic nephropathy

Pituitary gland disorders

Hyperpituitarism

Pituitary adenoma

Hyperprolactinemia

Prolactinoma

Gigantism

Acromegaly

Hypopituitarism

Growth hormone deficiency

Pituitary apoplexy

Sheehan syndrome

Hypoprolactinemia

Constitutional growth delay

Diabetes insipidus

Syndrome of inappropriate antidiuretic hormone secretion (SIADH)

Gonadal dysfunction

Precocious puberty

Delayed puberty

Premature ovarian failure

Polycystic ovary syndrome

Androgen insensitivity syndrome

Kallmann syndrome

5-alpha-reductase deficiency

Polyglandular syndromes

Autoimmune polyglandular syndrome type 1 (NORD)

Endocrine tumors

Multiple endocrine neoplasia

Pancreatic neuroendocrine neoplasms

Zollinger-Ellison syndrome

Carcinoid syndrome

Pheochromocytoma

Neuroblastoma

Opsoclonus myoclonus syndrome (NORD)

Endocrine system pathology review

Adrenal insufficiency: Pathology review

Adrenal masses: Pathology review

Hyperthyroidism: Pathology review

Hypothyroidism: Pathology review

Thyroid nodules and thyroid cancer: Pathology review

Parathyroid disorders and calcium imbalance: Pathology review

Diabetes mellitus: Pathology review

Cushing syndrome and Cushing disease: Pathology review

Pituitary tumors: Pathology review

Hypopituitarism: Pathology review

Diabetes insipidus and SIADH: Pathology review

Multiple endocrine neoplasia: Pathology review

Neuroendocrine tumors of the gastrointestinal system: Pathology review

Assessments

Thyroid eye disease (NORD)

USMLE® Step 1 questions

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Questions

USMLE® Step 1 style questions USMLE

of complete

A 50-year-old woman comes to the clinic due to insomnia and anxiety over the past few months. The patient’s last menstrual period was 1 year ago, but she denies hot flashes or vaginal dryness. The patient notes that her hair has become fine lately, and she has been losing weight without intention. On physical examination, a non-tender, diffuse goiter is noted. Laboratory tests show low TSH and high free T3 and T4 serum levels. The physician suspects that the patient’s condition is due to the most common cause of hyperthyroidism. Which of the following is the most specific finding for this condition?

Transcript

Content Reviewers

Yifan Xiao, MD

Contributors

Alex Aranda

Salma Ladhani, MD

Zachary Kevorkian, MSMI

Thyroid eye disease is a rare disease in which progressive inflammation damages muscle, fat and connective tissues around the eyes.

The disease has an active phase, which can last from six months to two years, where inflammation, swelling, and damage occur.

The inactive phase occurs when disease progression stops, but the tissue damage and symptoms remain.

Signs and symptoms can vary between individuals, but commonly the white parts of the eyes are inflamed.

A particularly noticeable change is the eyes appear to be bulging out of the eye socket, called exophthalmos or proptosis, which makes a person appear as if they are always ‘staring’.

Additionally, the eyes can feel irritated, uncomfortable, and have a “gritty” feeling.

They may also be constantly watery or be dry.

The eyelids can become inflamed and retracted, so they won’t close completely and blinking or trying to close the eyes can be painful.

Vision changes may also occur, including blurry vision; double vision; or an intolerance to bright lights.

In severe cases, vision may be threatened from increased pressure on the main nerve of the eye that carries visual information to the brain; or from dryness leading to erosion of the cornea, which is the outer part of the eye.

Thyroid eye disease usually occurs during middle age.

While it’s more frequent among females, males tend to have more severe cases.

Environmental factors such as smoking may contribute but there’s also a variety of genetic factors.

Individuals may have an elevated risk if they also have immune diseases like type 1 diabetes or rheumatoid arthritis.

Because thyroid eye disease occurs so often with Graves’ disease, it’s also called Graves’ orbitopathy, Graves’ ophthalmopathy, and thyroid-associated ophthalmopathy.

The exact underlying process by which thyroid eye disease occurs is not fully understood, but like Graves disease, it’s an autoimmune disorder.

Normally, the immune system protects the body by identifying and destroying foreign invaders; like bacteria, viruses or toxins.

Summary

Thyroid eye disease is a rare autoimmune disorder that affects the muscles and tissues around the eyes. It is caused by an overactive thyroid gland where there is a progressive inflammation that damages tissues around the eyes. Signs and symptoms of thyroid eye disease include eye redness, eye swelling out of the eye socket, called exophthalmos, and bulging, as well as double vision and sensitivity to light. Treatment may involve medications like corticosteroids, immunosuppressive drugs, and in some cases, orbital decompression surgery to relieve pressure on the eye.

Elsevier

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