Exophthalmos Treatment

[Spaceman Spif]

I always thought exophthalmos was treated with beta blockers? UWorld says corticosteroids? I know that it is a bunch of granulation tissue and inflammation that causes it due to hyperthyroidism. But this is the first time I have heard this. Thoughts?

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[preDoGuy24]

I always thought exophthalmos was treated with beta blockers? UWorld says corticosteroids? I know that it is a bunch of granulation tissue and inflammation that causes it due to hyperthyroidism. But this is the first time I have heard this. Thoughts?

I thought the exopthalmos seen in Graves disease was due to adipose and glycosaminoglycan deposition. I haven't learned it as an inflammatory process, but ive not done Uworld yet.


Realised I actually didn't help anything with that answer, searched on UPTODATE, here is one of their references-seems like glucocorticoids are commonly used for anti-inflammatory / immune suppression therapy in exopthalmus.

http://www.ncbi.nlm.nih.gov/pubmed?term=1422236

 

[MLT2MT2DO]

I always thought exophthalmos was treated with beta blockers? UWorld says corticosteroids? I know that it is a bunch of granulation tissue and inflammation that causes it due to hyperthyroidism. But this is the first time I have heard this. Thoughts?

USMLERrx says the same thing, it's the autoimmune with graves that attributes to the exopthalmos. Which I'm guessing is why you only see it Graves' and not all hyperthyroid disease states.

Regardless I remember that question and you should have been able to arrive at it through process of elimination, as it was definitely "the best possible answer"

 

[Suncrusher]

You can't treat the disease itself with B-blockers, but you can treat certain symptoms of Graves/hyperthyroidism/thyroid storm with B-blockers. However, you can't treat the exophthalmos symptom with B-blockers because it's due to certain fibroblasts being stimulated by the TSH-R-stimulating antibodies and secreting GAGs. I've also seen things about TSH-R-stimulating antibodies being simply deposited in certain areas (the antibodies localize behind the eyes and the shins because that's where those fibroblasts they cross-react with are) and causing inflammation-->GAGs, although somewhat more in the context of pretibial myxedema than exophthalmos. Either way, corticosteroids.

 

[Jambo1]

^What he said.

 

[Greenbayslacker]

just wanted to confirm the Tx of corticosteroids for exophthalmos based on UWorld Question 622

 

[Spaceman Spif]

just wanted to confirm the Tx of corticosteroids for exophthalmos based on UWorld Question 622

Randomly just saw/completed that question last night. Thanks guys!