Case Questions
Chief Complaint: I have swollen eyes
Demographic
Age: 40
Biological sex: Female
Race: White
Ethnicity: Not Hispanic or Latino
Medications
None
Before you continue, what questions do you want to ask this patient?
Burch HB, Perros P, Bednarczuk T, et al. Management of Thyroid Eye Disease: A Consensus Statement by the American Thyroid Association and the European Thyroid Association. Thyroid. 2022;32(12):1439-1470. doi:10.1089/thy.2022.0251 (image cropped)
ROS
Constitutional: Denies
Genitourinary: Denies
ENT: Denies
Musculoskeletal: Denies
Cardiovascular: Denies
Neurologic: Headaches
Pulmonary: Denies
Psychiatric: Denies
Endocrine: Denies
Immunologic: Denies
Dermatological: Denies
Hematologic: Denies
Gastrointestinal: Denies
Obstetrical: Denies
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OCT and VF 24-2 to rule out optic neuropathy
Orbital CT with contrast 3x3 or MRI to rule out orbital disease
Blood work to rule out endocrine disease
Format: [Testing] [Reason]
Example: Fundus photos to rule out retinal disease
Macovei ML, Georgescu RD. Papillitis in Neurosyphilis. Rom J Ophthalmol. 2019;63(4):406-411. (image cropped)
Burch HB, Perros P, Bednarczuk T, et al. Management of Thyroid Eye Disease: A Consensus Statement by the American Thyroid Association and the European Thyroid Association. Thyroid. 2022;32(12):1439-1470. doi:10.1089/thy.2022.0251 (image cropped)
Blood Work: Decreased TSH, Elevated T3 and T4
(no OCT available for this patient)
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Thyroid Eye Disease 2^ Graves Disease, OU
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Referred to endocrinologist for management and treatment of the underlying thyroid dysfunction. Instructed patient to use preservative-free artificial tears (PF ATs) every hour while awake and a lubricating ointment at bedtime (QHS) to manage ocular surface dryness. If dry eye symptoms are not adequately controlled, consider lid taping or punctal occlusion. Consider referral to oculoplastics for surgical eyelid recession following stabilization of proptosis. If the patient experiences diplopia, consider fresnel prisms or referral for strabismus surgery. At this time, there are no signs of optic neuropathy. If signs of optic nerve compression arise, initiate immediate treatment with oral steroids (prednisone 100 mg PO QD) for 2–14 days and refer to oculoplastics for orbital decompression. RTC in 1 month for evaluation of symptoms, VF 24-2, and OCT nerve.
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Educated patient on the diagnosis of thyroid eye disease (TED) secondary to Graves disease. Educated the patient on thyroid eye disease (TED) as a complication of Graves disease, emphasizing that the autoimmune nature of Graves can cause inflammation and swelling of the tissues around the eyes. This may result in symptoms such as eye irritation, dryness, eyelid retraction, proptosis, or double vision.