Grave`s ophtalmopathy

The result of increased volume of the retro-orbital tissues due to:

•Marked infiltration by T-cells with inflammatory edema

•Accumulation of glycosaminoglycans

•Increased numbers of adipocytes (fatty infiltration)

•Displacement of the eyeball forward

•Impairment of the function of extraocular muscles

Presentation of Grave`s ophtalmopathy

•Eyelid edema, periorbital edema

•Proptosis

•Incomplete close of eyelids during night

•Photophobia

•Eye discomfort, pruritus

•Painful eyes

•Dyplopia

Exophthalmos

Treatment of thyrotoxicosis

•Symptomatic treatment

•Oral rehydration for dehydrated patients

•Beta-blockers for relief of neurologic and cardiovascular symptoms

•For mild ophthalmopathy, saline eye drops as needed and tight-fitting sunglasses for outdoors

•For vision-threatening ophthalmopathy, high-dose glucocorticoids, with consideration for orbital decompression surgery and ocular radiation therapy

•Antithyroid drug treatment

•Methimazole is more potent and longer-acting than propylthiouracil

•Propylthiouracil is reserved for use in thyroid storm, first trimester of pregnancy, and methimazole allergy or intolerance

•Radioactive iodine treatment

•Thyroidectomy

Hypothyroidism

Persistent deficit of thyroid hormones

Causes

Hypothyroidism

1)Subclinical – TSH ↑, free Т4- N – asymptomatic or non-specific symptoms

2)Symptomatic – TSH ↑, free Т4. - ↓ - typical symtoms. May be asymptomatic

3)Complicated – TSH ↑, free Т4.- ↓ - Severe hypothyroidism with complications: polyserositis, heart failure, cretinism, coma, etc.

Signs and symptoms of hypothyroidism