Hyperthyroidism

Introduction to hyperthyroidism Hyperthyroidism is one of the common complications of Graves disease, also known as "hyperthyroidism", also known as "endocrine infiltrative eye disease", "endocrine exophthalmia", "invasive exophthalmos", "endocrine infiltration" Exophthalmos, etc., are complex eyelid diseases caused by various factors due to cell infiltration, edema, and connective tissue hyperplasia around the eyelids. Mainly affect the extraocular muscles, lacrimal glands and post-ocular fat. Most thyroid-related eye diseases are associated with hyperthyroidism, and most occur within 18 months or nearly 18 months after the onset of hyperthyroidism. There is a relationship between the orbital lesions and the nature and treatment of hyperthyroidism. In some typical patients with eyelid disease, abnormal thyroid function can be found in the clinical state of inflammation. There are pathophysiological differences in different patients, and doctors should treat them according to the specific conditions of patients. The effects of different periods of disease and lesions on the structure of the eyelids and the eye tissue should be adopted, and mutual cooperation, multiple methods, and drug-surgical treatment should be used to treat each other. Broadly speaking, the purpose of treatment is to relieve or control active lesions, prevent eye and psychophysiological damage, correct eye movement abnormalities, and improve patient appearance. basic knowledge The proportion of illness: 0.0005% Susceptible people: no special people Mode of infection: non-infectious Complications: conjunctival congestion, edema

Cause of hyperthyroidism

Disease factors (75%):

Most of the hyperthyroidism occurs simultaneously with hyperthyroidism. The prominent manifestations of hyperthyroidism are high metabolic syndrome and mental hyperactivity. However, some patients appear, aggravate or worsen after the hyperthyroidism relieves, or cures hyperthyroidism, or after hypothyroidism occurs.

Drug factors (20%):

If he is treated with western medicine, hemazole, etc., the condition has improved, but the exophthalmos has increased, and as the hyperthyroidism has been cured with 131 iodine, even hypothyroidism has occurred, but the exophthalmos has increased, and even formed a malignant eye. Some people have not seen hyperthyroidism, but they have emerged.

The disease is caused by the interweaving of gas, fire, phlegm and phlegm. Among them, the "fire" is the most prominent. The clinical fire has a real fire, such as heart and stomach fire, and there is a virtual fire such as yin deficiency fire. The real fire is also called a strong fire, "strong fire and gas", in the certain stage of the lesion can appear injury and yin.

Hyperthyroidism prevention

1, actively adjust the level of thyroid hormone, maintain in the normal range, avoid sudden reduction or increase in the amount of drugs.

2, to avoid spicy spicy food, quit smoking, to prevent eye fatigue, in the case of strong light, wear sunglasses, to avoid emotional excitement. When you are sleeping, your head is high, and those with cleft palate should be covered with eye ointment or wet room protection.

Hyperthyroidism Conjunctival congestion and edema

Because the eyeball is prominent, the eye can not be closed, the conjunctiva and cornea are exposed, causing congestion, edema, corneal ulceration, and even blindness.

Hyperthyroidism symptoms Common symptoms Visual impairment Eyeballs have foreign body sensation in the eye. There are small black spots, conjunctival hyperemia, diplopia, conjunctival edema, corneal ulcer, photophobia and high tearing thyroid hormone.

Common symptoms include photophobia, tearing, foreign body sensation, eye swelling, eyelid regurgitation, diplopia, and decreased vision.

Bilateral or unilateral eyeballs protrude, the eyelids are congested and edema, and the periorbital tissue is full.

The upper eyelid or lower eyelid retracts, and the upper eyelid falls slowly, which is called "late sign", and the blinking increases or decreases.

The conjunctiva is congested and edematous. In severe cases, the cleft palate is removed, and the conjunctival blood vessels at the attachment point of the muscles are increased. Even the thickened muscles can be seen in the internal and external rotation.

Restrictive ocular dyskinesia occurs when the extraocular muscle is involved.

Eyeballs are severely prominent, and corneal exposure can lead to exposed keratitis, which is most often affected by the lower edge of the cornea, and even forms endophthalmitis, which jeopardizes vision.

Long-term pressure increase, optic nerve traction, and phlegm muscle hypertrophy can be secondary to optic atrophy, visual field defects, color vision disorder, visual electrophysiological abnormalities, etc., severe vision loss, or even loss.

Long-term internal venous reflux disorder may be secondary to open-angle glaucoma, resulting in decreased vision and visual field defects.

Hyperthyroidism

Ultrasound examination : Ultrasound can show the appearance of extraocular muscle thickening, which is a fusiform middle and low echo.

CT scan : Coronal position can show that each extraocular muscle is thickened, and even a small number of patients can involve the superior and inferior oblique muscles. The axial position can better show the thickening of the internal and external rectus muscles, the bone of the inner wall of the iliac crest is thin, and the long-term pressure is increased. The sieving cardboard is concavely curved toward the sinus sinus, and the two sides are symmetric, and the name is Coke bottle. In the case of severe eyeballs, the optic nerve is pulled and loses its physiological curvature and is linear.

MRI examination : In addition to showing the same morphological changes as the CT scan, the signal changes of the extraocular muscles are related to the treatment. The extraocular muscles of the lesions have a medium or low signal in the T1-weighted image. T2-weighted images such as medium or low signal indicate severe muscle fibrosis, hormone shock therapy, chemotherapy or radiotherapy are not sensitive, and T2-weighted images such as high signal indicate muscle. In the period of inflammatory edema, the above treatment is relatively sensitive.

Diagnosis of hyperthyroidism

Differential diagnosis

1, myositis inflammatory pseudotumor

Acute onset, pain, eyelids, conjunctival congestion and edema, may be associated with ptosis, eye movement limitation, hormone shock or radiotherapy is more sensitive. Imaging examination can show irregular swelling of the extraocular muscles, muscle at the same time, and thickening of the eye ring.

2, intraorbital tumor

A variety of intraorbital tumors can cause eyeballs to stand out, and imaging studies can show round or fusiform masses in the iliac crest, which is highly confusing with a single hypertrophic thyroid-associated eye disease. However, the latter is more involved with both eyes, with typical eyelid signs and most patients with thyroid dysfunction.

3, the upper jaw drooping

When a monocular congenital, traumatic or secondary ptosis is gazing forward or upward, excessive nerve excitability is transmitted to the contralateral healthy eye, causing the upper palate to retreat and the palate to be too large, but no upper palate Fall, need to be identified.

4, other diseases in the extraocular muscles such as: parasitic cysts.

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