Cases reported "Thyroid Diseases"

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1/13. Severe Graves' ophthalmopathy after retrobulbar anesthesia for cataract extraction in a patient with mild stable thyroid eye disease.

    It has been hypothesized that the distinct anatomic localization of the Graves' triad may be partially explained by pressure and trauma. While there are reports of local trauma clearly contributing to the pathogenesis of pretibial myxedema, direct evidence for a similar mechanism in Graves' ophthalmopathy (GO) has been lacking. We describe a 65-year-old male patient with stable mild Graves' ophthalmopathy of 24 years' duration in whom a retrobulbar block was administered prior to cataract removal. Three weeks after the procedure, he complained of rapidly progressive bilateral diplopia. In 6 months, there was moderate exophthalmos, exposure keratitis, almost complete ophthalmoplegia, and decreasing visual acuity requiring surgical decompression. Postdecompression, inflammatory signs and vision improved but there was complete ophthalmoplegia. The eye signs remained unchanged for the next 4 months but there was exacerbation of the disease within a week of receiving radioiodine despite concomitant steroid administration. Orbital irradiation was finally administered with rapid improvement in extraocular eye muscle function. We hypothesize that local inflammatory and immune responses stimulated by trauma and/or pressure in the retrobulbar compartment, triggered the development of severe ophthalmopathy in this patient. Thyroid-stimulating immunoglobulin (TSI) levels remained markedly elevated despite the clinical improvement suggesting that the beneficial effects of radiotherapy in this case were not mediated by suppressing TSI production.
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keywords = ophthalmopathy
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2/13. A preliminary trial of high-dose intravenous immunoglobulin to a patient with euthyroid ophthalmopathy.

    A patient with serious euthyroid infiltrative ophthalmopathy was treated with oral glucocorticoids for five years. The course of the disorder was characterized by recurrent exacerbations during attempts to reduce the dose of systemic glucocorticoids. Intravenous infusion with high-dose immunoglobulin gave immediately favourable regression of the lesion, without side-effects. Possible modes of action of high-dose immunoglobulin treatment are discussed.
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ranking = 0.71428571428571
keywords = ophthalmopathy
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3/13. Necrotizing scleritis following strabismus surgery for thyroid ophthalmopathy.

    Necrotizing scleritis with inflammation of the right eye developed after bilateral eye muscle surgery for thyroid ophthalmopathy. Debilitating pain, delay in onset, and involvement of the sclera distinguish this condition from anterior segment ischemia. The surgery may have acted as a nonspecific trigger in an eye at risk for scleritis. Necrotizing scleritis has occurred infrequently after other types of eye surgery but, to our knowledge, has not been previously reported as a complication of eye muscle surgery.
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ranking = 0.71428571428571
keywords = ophthalmopathy
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4/13. Fadenoperation for the management of complicated incomitant vertical strabismus.

    We reviewed retrospectively the records of 17 patients with incomitant vertical diplopia secondary to an underacting inferior rectus muscle who had been treated by surgically weakening the contralateral inferior rectus muscle with a posterior fixation suture (fadenoperation). This was the sole procedure in four patients with blowout fractures and in two patients with restriction secondary to scleral buckling procedures. It was combined with horizontal or vertical muscle surgery in 11 patients. The procedure was particularly useful in preventing diplopia on downgaze after excessive weakening of a tight inferior rectus muscle in seven patients with thyroid ophthalmopathy. In three patients it was used in anticipation of an iatrogenic incomitancy in downgaze secondary to a large recession of a tight inferior rectus muscle. All patients were markedly improved after surgery and no complications were encountered.
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ranking = 0.14285714285714
keywords = ophthalmopathy
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5/13. Acute presentation of thyroid ophthalmopathy.

    Three patients are described who presented with acute painful proptosis, ptosis and ophthalmoplegia. orbital cellulitis was initially diagnosed in all cases, but there was no therapeutic response to antibiotics. A dramatic improvement occurred with steroids. All patients had, or developed abnormal thyroid tests and CT Scans showed thickened ocular muscles. This is an unusual presentation of thyroid ophthalmopathy.
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ranking = 0.71428571428571
keywords = ophthalmopathy
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6/13. Fine needle biopsy and scintigram in the preoperative diagnosis of thyroid lesions.

    Fine needle biopsies (FNB) of the thyroid were examined from 860 patients. In 703 cases follicular cells without atypia were found and in this group of patients the clinical diagnosis was nodular goitre. Operations were performed in 138 patients and in 97 cases the cytological finding could be correlated to the histopathological diagnosis. In 33 of these patients thyroid carcinoma was histologically verified. In 26 of the carcinoma cases cytologic examination showed grave atypia or changes indicating carcinoma. The cases in which the cytological diagnoses were falsely negative are discussed. Moderate cellular atypia occurred in one case with papillary carcinoma. In two cases the cytological examination gave a false positive diagnosis of cancer, both representing thyroiditis of the lymphoid type. The scintigrams in patients with thyroid carcinoma are also presented. Cold nodules were found in 10/19 patients and a hot nodule in .1 patient. In 3 patients the scintigrams were normal and in another 5 inconclusive. The results indicate that thyroid scintigrams can only be used as a supplement to the physical examination and a guidance for FNB. The contribution of FNB in the decision to operate is discussed and it is concluded that FNB is a valuable adjunct in preoperative diagnosis of thyroid lesions. The best diagnostic results are obtained when there is a close cooperation between clinician, radiologist, cytologist and pathologist.
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ranking = 0.00016493634724476
keywords = grave
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7/13. Upper eyelid retraction from inferior rectus restriction in dysthyroid orbit disease.

    Findings from orbital computed tomography scans have shown inflammatory enlargement of the levator palpebralis superioris complex to be a likely cause of eyelid retraction in dysthyroid (Graves's) ophthalmopathy. We have studied a subgroup of nine dysthyroid patients in whom the eyelid retraction occurs as a relative malposition of the globe and eyelid due to inferior rectus restriction. Our explanation of this phenomenon in nine patients is based on Hering's law. Increased innervation required for a fixating superior rectus muscle to overcome a severely restricted inferior rectus muscle causes an unrestricted levator muscle to open the eyelid abnormally wide relative to the globe. The retraction is best demonstrated with fixation of the involved eye. We have performed inferior rectus recession to correct this type of eyelid retraction in three of our patients.
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ranking = 0.14285714285714
keywords = ophthalmopathy
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8/13. Recovery of contrast sensitivity following bilateral orbital decompression: a case report.

    contrast sensitivity (CS) was measured in a patient with bilateral optic nerve compression resulting from thyroid ophthalmopathy. Initially both right and left contrast sensitivity functions (CSF's) were markedly attenuated over the spatial frequency range measured. CS improved significantly after surgical decompression although distance visual acuities remained unchanged during most of the period of observation. Sensitivity to medium- and high-spatial frequencies remained attenuated compared to the level achieved by a normal group of subjects of a similar age decade.
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ranking = 0.14285714285714
keywords = ophthalmopathy
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9/13. The use of adjustable sutures.

    The indications for and details of the technique of adjustable sutures are fully described. patients with vertical strabismus and fusion give significantly better results with this method. Illustrative cases of dysthyroid ophthalmopathy and superior oblique palsies are described.
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ranking = 0.14285714285714
keywords = ophthalmopathy
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10/13. diplopia in autoimmune thyroid disease.

    diplopia without obvious exophthalmos, caused by infiltrative endocrine ophthalmopathy, developed in 12 patients with clinical and laboratory confirmation of autoimmune thyroid disease. In eight patients, the diplopia alone prompted medical attention, which led to the diagnosis of autoimmune thyroid disease. A hypotropia secondary to restrictive tightening of the inferior rectus muscle, producing vertical diplopia, was the most common manifestation of the disorder. The ocular muscle imbalance in autoimmune thyroid disease is caused by mechanical orbital restriction of the extraocular muscle, not by an innervational defect. Evidence of orbital restriction of the eye muscles can establish the diagnosis, regardless of the patient's thyroid function.
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ranking = 0.14285714285714
keywords = ophthalmopathy
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