How to elicit the eye signs of thyroid disease an OSCE guide

Following are the important eye sign in thyroid disease.

1.Exophthalmos: Unilateral or bilateral.

Comment on the widened palpebral fissure, visibility of the sclera above and below the limbus.

2. Von Graefe's sign:

3. Stellwag's sign Observe for retraction of upper eyelid and Infrequent blinking.

4.Joffroy's sign

5.Moebles sign: Look for Inability to converge the eyes.

How to elicit Von Graefe's sign:an OSCE guide

Von Graefes sign is an important eye sign in hyperthyroidism.It is elicited as follows

• The patient looks straight ahead.
• Ask the patient to look down.
• Look for a lag of the upper eyelid.

It is the lagging of the upper eyelid on downward rotation of the eye and indicate  underlying  Graves' Disease

The terms lid lag and von Graefe's sign have been used interchangeably in the past; but, they are distinct signs of downgaze-related upper eyelid static position and dynamic movement, respectively.

What are the causes of thyrotoxicosis ?

Thyrotoxicosis is defined as the state of thyroid hormone excess. 

But it is not synonymous with hyperthyroidism, which is the result of excessive thyroid function.

Following are the causes of thyrotoxicosis

• Primary hyperthyroidism 
• Thyrotoxicosis without hyperthyroidism
• Secondary hyperthyroidism 

1. Primary hyperthyroidism

Graves' disease.

Toxic multinodular goiter.

Toxic adenoma.

Functioning thyroid carcinoma metastases.

Activating mutation of the TSH receptor.

Activating mutation of Gs alpha (McCune-Albright syndrome.  Struma ovarii ).

Drugs-iodine excess.

2.Thyrotoxicosis without hyperthyroidism

Subacute thyroiditis. 

Silent thyroiditis.

Other causes of thyroid destruction are amiodarone, radiation, infarction of adenoma.

Ingestion of excess thyroid hormone (thyrotoxicosis factitia) or thyroid tissue.

3.Secondary hyperthyroidism

TSH-secreting pituitary adenoma. 

Thyroid hormone resistance syndrome. 

Chorionic gonadotropin-secreting tumors.

Gestational thyrotoxicosis.