| Identifier |
Thyroid_Eye_Disease_1080p_Lee |
| Title |
Thyroid Eye Disease |
| Creator |
Andrew G. Lee, MD; Zainub Abdullah |
| Affiliation |
(AGL) Chairman, Department of Ophthalmology, The Methodist Hospital, Houston, Texas; Professor of Ophthalmology, Weill Cornell Medicine, New York City, New York; (ZA) Baylor College of Medicine, Houston, Texas |
| Subject |
Thyroid; Hashimoto's; Grave's |
| Description |
Dr. Lee lectures medical students on the subject of thyroid eye disease. |
| Transcript |
I want to tell you a little bit about thyroid eye disease there are other videos on thyroid eye disease but today I just want to concentrate on one thing and the concept I want to emphasize to you about TED, thyroid eye disease, is that it's an immunologic disorder, and even though we're going to control the hormones, it's not really a hormone thing. It is an immunologic problem and that is super important because your thyroid eye disease can occur with either hyperthyroid(too high), which is Grave's disease or it can be too low, Hashimoto's thyroiditis, and then the most dangerous category is the euthyroid Grave's orbitopathy. So, they have all the typical findings of thyroid eye disease: the lid retraction and the lid lag the diplopia from the ophthalmoplegia. And that's usually the inferior medial, superior, and lateral rectus last. They might have a compressive optic neuropathy from compression of the orbital apex and proptosis. So, it looks just like regular thyroid eye disease but their thyroid function studies, their hormones, are all normal. So, in those patients we need to do the immunologic testing, which is the thyroid peroxidase antibody and the thyroid stimulating immunoglobulin in our hospital. If you have the thyroid stimulating immunoglobulin, that's going to bind onto the TSH receptor on the thyroid gland and cause high thyroid and that disease is called Grave's disease. If it's the TPO antibody, the thyroid peroxidase antibody, it's going to damage the thyroid colloid, and that usually causes low thyroid(which is Hashimoto's). But sometimes the colloid releases the thyroid transiently and that can cause thyrotoxicosis even though you're Hashimoto's and we call that hashi-toxicosis. So these are hypothyroid and hyperthyroid on an autoimmune basis Both of these can be associated with thyroid eye disease and what's the fascinating part about the disorder is the immunoglobulin that is produced. There's some sort of unknown antigen, that antigen is picked up by antigen presenting cell then there's some sort of MHC complex interaction with the T-helper cell. That T-helper cell is going to differentiate into subsets that's going to release interleukins and inflammatory cytokines. This t cell is going to talk to a B-cell. That B-cell is going to be told to make an immunoglobulin against this antigen and if that antigen happens to look like the TSH receptor or the thyroid peroxidase then the antibodies produced by this differentiated B-cell into plasma cell will then cause the clinical downstream effects on the thyroid. The fascinating part however is that this same antibody goes to the orbital fibroblast and that is a blast, so the fibroblasts can become adipocyte and increase the fat in the orbit, or it can become myocyte and become big muscles. So, we can have both big muscles and big fat from stimulating this fibroblast and this fibro part can make glycosamino glycans and as you know those glycosamino glycans bring water to the site and that will cause edema. So, all the clinical findings that we see: the lid retraction the lid lag the, ophthalmoplegia, the diplopia, the compressive optic neuropathy from the big muscles of the orbital apex, and the proptosis are not due to the hormones they're due to the immunologic response that we're seeing in the orbit at the orbital fibroblast level leading to both the fibroblast differentiation into other cell types(big fat and big muscles) and the production of glycosamino glycans that leads to local edema and that is a fascinating process because it's an antibody thing, not a hormone thing and that means you could be complete lyeuthyroid. |
| Date |
2021-06 |
| Language |
eng |
| Format |
video/mp4 |
| Type |
Image/MovingImage |
| Collection |
Neuro-Ophthalmology Virtual Education Library: Andrew G. Lee Collection: https://novel.utah.edu/Lee/ |
| Publisher |
North American Neuro-Ophthalmology Society |
| Holding Institution |
Spencer S. Eccles Health Sciences Library, University of Utah |
| Rights Management |
Copyright 2019. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s68d5w0s |
| Setname |
ehsl_novel_lee |
| ID |
1701589 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s68d5w0s |
