Jag har låg ämnesomsättning och koncentrerar mig därför på det, men med anledning av inlägget Anmälan till IVO (Inspektionen för vård och omsorg) där patienten inledde sin sjukdomshistoria med hög ämnesomsättning har jag fått ett mail från Dr Helena Rooth Svensson. Dr Helena skriver:
TRAK=antikroppar som stimulerar tyreoidahormon receptorer (TR) = TSH-receptorer i follikelcellerna i sköldkörteln för att mer jod och tyrsoin ska tas upp till körteln och därmed bilda mer T4 och T3, vilket ger “giftstruma”.
I ögonen finns TSH-receptorer som stimuleras av TRAK, vilket ger inflammation.
Utifrån patienten berättelsen skulle jag idag förorda att alla med positiv TRAK bör ögonspecialist undersökas.
Följande text bifogas också:
Clinical characteristics of dysthyroid optic neuropathy
Elyashiv S, Skaat A, Ben Simon G, Huna-Baron R
PURPOSE:
To describe the clinical presentation, management and outcome of dysthyroid optic neuropathy (DON) patients in order to find markers for this diagnosis among Graves orbitopathy (GO) patients.
METHODS:
We conducted a retrospective review of the medical records of 15 patients presenting with clinical and radiologic evidence of DON, from a series of 131 patients with Graves orbitopathy, treated at our health care center between the years 1999 and 2008. The worse eye of each of the 15 DON patients was determined according to visual acuity and visual field defects, and was paired with an eye of a matched patient from the GO group. Paired comparisons were performed in order to appreciate the differences in the rates of various signs and symptoms between both groups.
RESULTS:
A total of 15 patients (11%), mean age 55 years (range 37-76 years) were diagnosed with DON, (53%) of them were smokers. The most common manifestations among DON patients were proptosis (78%), visual field defects (76%) and restriction of abduction (73%). In a paired comparison between the worse eye of DON patients and their counterparts in the GO group, statistically significant differences were noted in the rate of proptosis (p = 0.02), extent of visual field damage (p = 0.001), visual field mean deviation (p = 0.02) and abduction limitation (p = 0.02). A trend with no statistical significance was demonstrated for the difference in adduction limitation (p = 0.06).
CONCLUSIONS:
The clinical presentation and management of dysthyroid optic neuropathy patients is described in a cohort of 15 patients. As visual field defects and restriction of abduction were the most common signs with the diagnosis of optic neuropathy, we recommend follow-up to include routine visual field screening in Graves’ orbitopathy patients. Treatment with intravenous corticosteroids and decompressive surgery was shown to be effective in our cohort.