Infiltrative Ophthalmopathy Research Articles

Infiltrative Ophthalmopathy and Primary Hypothyroidism

Case Studies1 August 1967Infiltrative Ophthalmopathy and Primary HypothyroidismROBERT A. FOX, M.D., THEODORE B. SCHWARTZ, M.D., F.A.C.P.ROBERT A. FOX, M.D.Search for more papers by this author, THEODORE B. SCHWARTZ, M.D., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-67-2-377 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptExophthalmos and associated eye changes are classically linked with hyperthyroidism in the form of Graves' disease, and the ophthalmopathy may persist or progress in severity even though the euthyroid state is restored or hypothyroidism supervenes. In recent years it has become evident that infiltrative ophthalmopathy may occur in euthyroid individuals in whom there is no evidence of prior hyperthyroidism (1-4). This report is presented primarily to draw attention to the fact that infiltrative ophthalmopathy may also appear in hypothyroid individuals without a previous history of hyperthyroidism.CASE REPORTPatient B. T. (PSLH 795904) is a 40-year-old white housewife who was...

Graves' disease without hyperthyroidism

Five patients with infiltrative ophthalmopathy and positive serum assays for the long-acting thyroid stimulator of Graves' disease were studied in an attempt to understand why they did not have hyperthyroidism. Serum proteinbound iodine concentrations and thyroid uptake of I 131 were not greater than normal. When studied, the effective half-life of thyroid I 131 was abnormally short, and thyroid uptake of I 131 was not suppressed by administration of thyroid hormones. Of key importance to this study is the fact that these patients were found to be incapable of responding to large doses of thyrotropin with increases in thyroid secretion rates, serum protein-bound iodine or thyroid uptake of I 131. It was concluded that in all five patients hyperthyroidism had failed to develop, even though the long-acting thyroid stimulator was present in their plasma, because some prior lesion had limited the capacity of the thyroid glands to respond to thyroid-stimulating hormones. Analogous observations were made in three additional patients who had had classic Graves' disease and whose hyperthyroidism had been cured by partial thyroid ablation.

Adrenal steroid therapy of severe infiltrative ophthalmopathy of Graves' disease

During the six years, 1955 to 1960, nineteen of a group of 101 patients with the infiltrative ophthalmopathy of Graves' disease were treated with adrenal corticosteroids. They represented patients with the most severe ophthalmic complications, four having papilledema, eight severe visual loss, and all, marked ophthalmoplegia. Prednisone or its equivalent was administered initially in doses of 35 to 80 mg. daily for one to eight weeks and the dose then was reduced gradually. Total duration of therapy averaged ten months. In all patients there was a decrease in chemosis and injection of the conjunctivas, ten noted improvement in ocular mobility, and thirteen observed a significant decrease in proptosis. Vision improved in all eight patients who exhibited severe impairment. Four patients were considered therapeutic failures. In two, the medication was stopped or reduced rapidly, and in a third, orbital decompression was performed without an attempt to control symptoms with increased doses of steroids. One patient had psychotic symptoms, and three patients had peptic ulcers. Side effects of therapy, otherwise, could be managed symptomatically. Visual loss is an absolute indication for treatment with adrenal steroids. Rapidly progressive proptosis with severe ophthalmoplegia and inflammatory changes are relative indications for steroid therapy.

Localized pretibial myxedema: report of two cases treated with hydrocortisone by local injection.

Excerpt Reports of successful means of treatment for localized pretibial myxedema are of interest because of its close relationship with progressive exophthalmos, and the possibility that the same ...

Exophthalmos of Graves' disease: a summary of the present status of therapy.

Excerpt Graves' disease may be considered to be a thyroid-pituitary syndrome. The two chief manifestations of the disorder are exophthalmos and hyperplastic goiter with hyperthyroidism. They usuall...

Endocrine aspects of exophthalmos.

This discussion will be limited to the unique constellation of ophthalmopathic phenomena in which exophthalmos is only one of several manifestations and which has been known variously as malignant or progressive exophthalmos, hyperophthalmopathic Graves' disease, exophthalmic ophthalmoplegia, and the infiltrative ophthalmopathy of Graves' disease. It is usually accompanied by hyperthyroidism but may occur in euthyroid persons or occasionally in patients who are in a hypothyroid state throughout. Milder variants of the syndrome have even been described in Cushing's disease. After more than a century of fruitless speculation concerning its etiology and pathogenesis, interest began to center on the adenohypophysis as an important factor about 20 years ago, and in 1944 the nosological concept of Mulvany 1 further influenced this trend of thought. This concept divided exophthalmos into thyrotoxic and thyrotropic types. The former (thyrotoxic) included the milder syndromes manifested chiefly by exophthalmos, lid retraction, and thinning of the extrinsic muscles;