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I) Review of normal thyroid function
II) Hyperthyroidism
A.
B.
C.
D.
Common, with annual incidence of about 1%
Approximately 1 in 20 women during lifetime
80% from Grave’s disease
Solitary toxic nodules and multi-nodular goiter
III) Thyroid Orbitopathy: Ophthalmic Clinical Workup
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
Complete history with prior treatment
Comprehensive ocular health assessment
Evaluation for eyelid and soft tissue inflammation
Positional IOP fluctuation
Color vision testing
Exophthalmometry
ONH evaluation
Axial and coronal MRI
Saccadic velocity
P-VEP
Pattern visual evoked potentials
IV) Disthyroid Orbitopathy (DON)
A.
B.
C.
D.
E.
F.
G.
H.
I.
Serious complication of Grave’s disease
5% of Grave’s Orbitopathy
Compression of ON or blood supply at the orbital apex
Adipogenesis and swollen EOM’s
Disthyroid orbitopathy (DON)
Toxic
Mechanical
Vascular
Ischemic
V) Staging the Disease
A.
B.
C.
D.
Phase of intense activity
Plateau phase
Spontaneous regression
Post-inflammatory (refractory stage)
VI) Gender and Autoimmune Disease
VII) Tx for Hyperthyroidism
A. RadioIodine I131
B. Surgical thyroidectomy
C. Anti-thyroid medication
VIII) Cancer Mortality Following Tx with I131 for Adult Hyperthyroidism Cooperative
Thyrotoxicosis Therapy Follow-up Study
A.
B.
C.
D.
E.
F.
G.
H.
Began in 1961
26 clinical sites
35,609 pts treated for hyperthyroidism
Treatment span 1946-1964
Cooperative Thyrotoxicosis Therapy Follow-up Study
91% Grave’s disease
79% female
65% treated with I131
IX) Cooperative Thyrotoxicosis Therapy Follow-up Study
Conclusion of Study
X) Unexpected Complications of Therapeutic I131
XI) Medical and Surgical Considerations in Grave’s Orbitopathy
A.
B.
C.
D.
Focal triamcinolone injections.
Paradigm shift in orbital decompression surgery
Intraconal fat removal
Initial superficial and deep lateral wall removal
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