0:00

This was a pretty clear cut case of,

0:02

of Graves disease and really one of the most severe cases I've seen.

0:05

And I don't think anyone really had much of a problem with this case.

0:08

The one thing that I,

0:09

I did wanna point out on this is that in cases of Graves disease,

0:13

it has a propensity to involve the inferior rectus and the medial rectus muscle.

0:17

And this case it was involving all of the muscles and in fact,

0:20

this very nicely shows the superior rectus muscle as well too.

0:24

The one thing that I did want to to say is that, you know,

0:27

all of you all I think got this case right,

0:30

but really when we talk about the fellow level stuff, uh,

0:33

when it comes to something like Graves' disease is that it is important, uh,

0:37

in your report is to go ahead and mention whether or not the fat planes

0:43

that are located at the orbital apex are intact. Because if a patient,

0:47

uh, what Graves' disease can do is that it can give you a compressive optic

0:52

neuropathy where the patients can begin to lose their vision.

0:55

And what the surgeons can do is do an an,

0:58

an orbital decompression where they actually go in and they can remove the

1:02

borders of the, uh,

1:04

bony margins of the optic nerve at the orbital apex.

1:08

So they can remove part of the lamina capricia.

1:10

They may could potentially remove the, uh, lateral wall of the gradle sphenoid.

1:15

So the, uh, the, um, excuse me, I can't talk today, the, um,

1:19

greater we of the sphenoid, which forms a lateral wall of the orbit.

1:23

So I think it is important that you go ahead and mention that in your report.

1:28

Now what I wanted to do too is, um, just give, uh, just a couple of,

1:33

uh, real quick slides, um, on Graves' disease. So hold on,

1:37

lemme just bring that up. Or thyroid ophthalm osteopathy.

1:40

So just lemme bring that up here. So this is just another example of,

1:45

um, thyroid ophthalm osteopathy. So this is an example of Grave's disease, uh,

1:49

again, uh, very nicely showing the medial rectus, the inferior rectus,

1:53

superior rectus and lateral rectus. Now, when you do look at Graves disease,

1:57

realize the muscles also enhance with contrast.

2:00

And the classic thing that was initially described with Graves disease is that

2:04

you can have abnormal enhancement here of the muscle belly with relative sparing

2:08

of the tendons. So when the muscles do attach to the,

2:11

have their tendons insertion along the sclera, uh,

2:15

just realize that in general the tendons tend not to

2:20

tend not to be involved. So here's another example here.

2:24

This is actually comparing thyroid ophthalm osteopathy with pseudotumor.

2:27

So this is the classic case of thyroid pathy.

2:30

You can see the involvement is involved in the muscle belly.

2:33

But then when we look at the pseudotumor,

2:35

when it comes to myo acidic forms of pseudotumor,

2:38

we'll talk about pseudotumor a little bit later,

2:41

but when you have this form that actually involves the muscles, in theory,

2:45

the muscle tendon is gonna be enlarged and involved where it's relatively spared

2:50

in, in thyroid pathy. The other thing, clinically, it's, it's,

2:54

it's pretty s much easier clinically to separate between pseudo two and

2:58

Thyroid pathy. So if you did see a patient with thyroid pathy,

3:03

these patients tend not to have orbital pain.

3:05

They do have proptosis as is seen here,

3:08

but in pseudotumor they tend to have a lot of retrobulbar pain.

3:12

So from a clinical standpoint, you know, it's, it's relatively easy to,

3:16

to differentiate between pseudotumor and thyroid Pathy.