{
  "$schema": "https://ui.shadcn.com/schema/registry-item.json",
  "name": "graves-disease",
  "title": "Graves' disease",
  "description": "Graves' disease on the thyroid and the eye: a diffuse goitre, then thyroid eye disease swelling the extraocular muscles, through thyrotoxicosis, active eye disease and burnt-out fibrosis, with the thyroid function, antibodies and eye measurements at each stage. Models licensed CC BY-SA 2.1 JP (thyroid and eye).",
  "registryDependencies": [
    "@organui/disease-viewer",
    "@organui/thyroid",
    "@organui/eye"
  ],
  "files": [
    {
      "path": "registry/base-nova/graves-disease/graves-disease.tsx",
      "content": "import { diseaseModel, type Disease } from \"@/components/disease-model\"\nimport {\n  DiseaseViewer,\n  type DiseaseViewerProps,\n} from \"@/components/disease-viewer\"\nimport { eyeModel } from \"@/components/eye\"\nimport { thyroidModel } from \"@/components/thyroid\"\n\nconst goitre =\n  \"Antibodies against the TSH receptor switch the gland on: it grows evenly into a smooth goitre and overproduces thyroid hormone.\"\n\n// Graves' disease on the thyroid, where the antibodies drive the gland, and\n// on the eye, where the same autoimmunity swells the muscles behind it.\nexport const gravesDisease: Disease = {\n  name: \"Graves' disease\",\n  code: \"E05.0\",\n  summary:\n    \"Autoantibodies stimulate the TSH receptor, causing hyperthyroidism with a diffuse goitre. In about a quarter of people, the same immune attack swells the tissues behind the eyes.\",\n  scales: [\n    {\n      id: \"thyroid\",\n      label: \"Thyroid\",\n      model: thyroidModel,\n      findings: {\n        \"right-lobe\": { affected: true, description: goitre },\n        \"left-lobe\": { affected: true, description: goitre },\n        isthmus: {\n          affected: true,\n          description:\n            \"Enlarged with the lobes, so the goitre is symmetrical and moves up when the patient swallows.\",\n        },\n        \"superior-thyroid-artery\": {\n          affected: true,\n          description:\n            \"Blood flow through the gland rises, and a bruit can be heard over it with a stethoscope.\",\n        },\n        trachea: {\n          affected: false,\n          description:\n            \"A Graves' goitre is usually modest and rarely narrows the trachea, unlike a large multinodular goitre.\",\n        },\n        \"right-inferior-parathyroid\": {\n          affected: false,\n          description:\n            \"Unaffected by the disease. At thyroidectomy the parathyroids must be preserved, or calcium falls afterwards.\",\n        },\n        \"right-recurrent-laryngeal-nerve\": {\n          affected: false,\n          description:\n            \"Unaffected by the disease, but it runs behind the gland and is at risk during thyroidectomy, causing hoarseness.\",\n        },\n      },\n    },\n    {\n      id: \"eye\",\n      label: \"Eye\",\n      model: eyeModel,\n      defaultView: \"Lateral\",\n      findings: {\n        \"levator-palpebrae\": {\n          affected: true,\n          description:\n            \"Excess thyroid hormone drives the sympathetic Müller's muscle beneath it, so the upper lid retracts and lags behind the eye when looking down, giving a staring look.\",\n        },\n        \"inferior-rectus\": {\n          affected: false,\n          description:\n            \"Normal at first. It is the muscle most often enlarged once eye disease begins.\",\n        },\n        \"optic-nerve\": {\n          affected: false,\n          description:\n            \"Normal. Swollen muscles crowding the orbital apex can compress it, a sight-threatening emergency.\",\n        },\n      },\n    },\n  ],\n  stages: [\n    {\n      id: \"thyrotoxic\",\n      label: \"Thyrotoxic\",\n      summary:\n        \"Weight loss, tremor, heat intolerance and palpitations. Beta blockers ease the symptoms while carbimazole lowers hormone production.\",\n    },\n    {\n      id: \"active-eye\",\n      label: \"Active eye\",\n      summary:\n        \"Active thyroid eye disease. The muscles and fat behind the eye swell and push it forward; stopping smoking and treating early limit the damage.\",\n      findings: {\n        eye: {\n          \"inferior-rectus\": {\n            affected: true,\n            description:\n              \"The most often enlarged muscle. Swollen with lymphocytes and water-binding glycosaminoglycans, it tethers the eye, so looking up causes double vision.\",\n          },\n          \"medial-rectus\": {\n            affected: true,\n            description:\n              \"Next most often enlarged. Its tendon is spared on CT or MRI, which tells thyroid eye disease from orbital myositis.\",\n          },\n          \"superior-rectus\": {\n            affected: true,\n            description:\n              \"Enlarged with the levator above it. Swollen and tight, it restricts looking down.\",\n          },\n          cornea: {\n            affected: true,\n            description:\n              \"Proptosis and lid retraction leave it exposed, so the eyes feel gritty and water. Lubricants protect it.\",\n          },\n          \"optic-nerve\": {\n            affected: false,\n            description:\n              \"Still normal, but checked at every visit: falling colour vision or acuity means compression and needs urgent steroids or decompression.\",\n          },\n        },\n      },\n      investigations: [\n        { name: \"Clinical activity score\", result: \"4 of 7\", flag: \"high\" },\n        { name: \"Exophthalmometry\", result: \"23 mm\", flag: \"high\" },\n        { name: \"Orbit MRI\", result: \"Enlarged muscles\", flag: \"abnormal\" },\n        { name: \"Colour vision\", result: \"Normal\" },\n      ],\n    },\n    {\n      id: \"inactive\",\n      label: \"Inactive\",\n      summary:\n        \"After one to two years the eye disease burns out. The thyroid is controlled; any remaining proptosis or squint can now be corrected surgically.\",\n      findings: {\n        thyroid: {\n          \"right-lobe\": {\n            affected: true,\n            description:\n              \"Treated: carbimazole for 12 to 18 months, or radioiodine or surgery, after which levothyroxine replaces the hormone for life.\",\n          },\n          \"left-lobe\": {\n            affected: true,\n            description:\n              \"Treated with the right lobe; about half of people relapse after a course of carbimazole.\",\n          },\n          isthmus: {\n            affected: true,\n            description:\n              \"Treated with the lobes. The goitre shrinks with control, and is gone after radioiodine or surgery.\",\n          },\n          \"superior-thyroid-artery\": {\n            affected: false,\n            description:\n              \"Blood flow returns to normal once the thyroid is controlled, and the bruit goes.\",\n          },\n        },\n        eye: {\n          \"inferior-rectus\": {\n            affected: true,\n            description:\n              \"Fibrosed and shortened. The restriction is now fixed; squint surgery can correct the double vision.\",\n          },\n          \"medial-rectus\": {\n            affected: true,\n            description:\n              \"Fibrosed, with less swelling than in the active phase.\",\n          },\n        },\n      },\n      investigations: [\n        { name: \"TSH\", result: \"Normal\" },\n        { name: \"TRAb\", result: \"Falling\" },\n        { name: \"Clinical activity score\", result: \"0 of 7\" },\n        { name: \"Exophthalmometry\", result: \"22 mm\", flag: \"high\" },\n      ],\n    },\n  ],\n  investigations: [\n    { name: \"TSH\", result: \"Suppressed\", flag: \"low\" },\n    { name: \"Free T4\", result: \"Raised\", flag: \"high\" },\n    { name: \"TRAb\", result: \"Positive\", flag: \"abnormal\" },\n    { name: \"Heart rate\", result: \"112 / min\", flag: \"high\" },\n  ],\n}\n\n/** The thyroid when thyrotoxic, the scale and stage the viewer opens on. */\nexport const gravesDiseaseModel = diseaseModel(gravesDisease)\n\nexport type GravesDiseaseProps = Omit<DiseaseViewerProps, \"disease\">\n\nexport function GravesDisease(props: GravesDiseaseProps) {\n  return <DiseaseViewer disease={gravesDisease} {...props} />\n}\n",
      "type": "registry:component"
    }
  ],
  "docs": "Graves' disease docs: https://organui.com/docs/components/graves-disease. It reuses the thyroid model, licensed CC BY-SA 2.1 JP (https://creativecommons.org/licenses/by-sa/2.1/jp/deed.en) and the eye model, licensed CC BY-SA 2.1 JP (https://creativecommons.org/licenses/by-sa/2.1/jp/deed.en); keep the viewer's credit visible. Educational, not for diagnosis.",
  "categories": [
    "disease",
    "endocrine"
  ],
  "type": "registry:component"
}