Graves' ophthalmopathy. Is it really thyroid disease?

Abstract

The triad of hyperthyroidism, diffuse goiter, and ophthalmopathy was identified as a disease entity by Parry, 1 Graves, 2 and von Basedow 3 in the first part of the 19th century. Although there is a strong temporal relationship between the onset of hyperthyroidism and eye symptoms, 4 many patients with hyperthyroidism do not experience clinical eye findings, and some patients with ophthalmopathy fail to manifest overt or subclinical signs of thyroid dysfunction. 5-9 The absence of a consistent linkage between the thyroid disease and the eye disease has been an impediment to the identification of a common causal agent and to agreement on the optimal clinical management of the ophthalmopathy. See also p 1098. Graves' disease is considered to be autoimmune in origin. Thyroid-stimulating immunoglobulins stimulate the thyroid-stimulating—hormone receptor on the thyroid cell membrane. 10 Some thyroid-stimulating immunoglobulins were once thought to cause ophthalmopathy, but that belief is no longer