Proptosis In Patients Research Articles

Graves Exophthalmos Unrelated to Extraocular Muscle Enlargement: Superior Rectus Muscle Inflammation May Induce Venous Obstruction

Exophthalmos is the most commonly measured sign of Graves ophthalmopathy, whereas enlargement of the extraocular muscles is the principal pathologic abnormality. The purpose of this article is to explore possible etiologies of increased volume of orbital fat and of proptosis in patients with no substantially increased total extraocular muscle volume. Computed tomographic scans of the 13 orbits reviewed in this study had the following characteristics in common: a fine, reticular pattern within the orbital fat, a prominent superior ophthalmic vein, and an enlarged superior rectus muscle. Quantitative analysis revealed that superior rectus muscle volume showed a statistically significant correlation with proptosis, whereas medial, lateral, and inferior rectus muscle volumes did not correlate with proptosis. Based on anatomic considerations, the authors postulate that superior rectus muscle enlargement alone may produce reduced venous outflow from the orbit, thereby expanding the apparent orbital fat volume and producing proptosis.

Retraction of the lower eyelid.

Retraction of the lower eyelid is a useful sign of disease. It is an early manifestation of weakness of the facial muscles, occurring with myopathies, myasthenia, and upper and lower motor neuron facial paresis. Rarely, lower and upper lid retraction occur without proptosis in patients with Graves disease. Lower lid retraction occurs in proptosis and varies directly with the degree of proptosis. It is also seen with senile entropion or ectropion, after eye muscle or orbital surgery, and with contraction of lid tissues. Apparent retraction results when the contralateral lower lid is pathologically elevated, as in Horner syndrome, in enophthalmos, or with vertical deviations of the eye.

Humoral factors in the pathogenesis of Graves' disease.

Humoral factors in the pathogenesis of Graves' disease.J M McKenzieJ M McKenziePublished Online:01 Jan 1968https://doi.org/10.1152/physrev.1968.48.1.252MoreSectionsPDF (11 MB)Download PDF ToolsExport citationAdd to favoritesGet permissionsTrack citations ShareShare onFacebookTwitterLinkedInWeChat Previous Back to Top Download PDF FiguresReferencesRelatedInformation Cited ByHyperthyroidism, Exophthalmos, and Goiter: Historical Notes on the OrbitopathyThyroid, Vol. 20, No. 3TSH Receptor AntibodiesThyroid, Vol. 17, No. 10Course of Proptosis in Patients With Graves' Disease After Endoscopic Orbital DecompressionThe Laryngoscope, Vol. 109, No. 8Thyroid DysfunctionEndocrinology and Metabolism Clinics of North America, Vol. 17, No. 3The Spectrum and Significance of Autoantibodies Reacting with the Thyrotropin ReceptorEndocrinology and Metabolism Clinics of North America, Vol. 16, No. 2Ocular Manifestations of Graves' Disease: A Review29 June 2016 | Journal of the Royal Society of Medicine, Vol. 77, No. 11Graves' ophthalmopathy. A clinical and immunologic reviewSurvey of Ophthalmology, Vol. 26, No. 1NOMENCLATURE OF THYROID-STIMULATING ANTIBODIESThe Lancet, Vol. 305, No. 7917CONGENITAL-MALFORMATION RATES AND SPONTANEOUS-ABORTION RATESThe Lancet, Vol. 305, No. 7917Association of the long-acting thyroid stimulator protector with the immunoglobulin G fraction of serum from patients with thyrotoxicosisBiochimica et Biophysica Acta (BBA) - Protein Structure, Vol. 379, No. 1Does lats cause hyperthyroidism in Graves' disease?Metabolism, Vol. 21, No. 9Current status and future prospects for research in psychosomatic medicineJournal of Psychiatric Research, Vol. 8, No. 3-435S-sulfate uptake by mouse harderian gland: Effect of serum from patients with Graves' diseaseMetabolism, Vol. 20, No. 4The lipolytic activity of long-acting thyroid stimulatorBiochimica et Biophysica Acta (BBA) - Lipids and Lipid Metabolism, Vol. 231, No. 2Characterisation of long-acting thyroid stimulator γG binding proteinBiochimica et Biophysica Acta (BBA) - Protein Structure, Vol. 229, No. 3Studies of homologous immunization with mouse harderian glandMetabolism, Vol. 20, No. 3In vitro influence of thyrotropin or long-acting thyroid stimulator on mouse thyroid membrane potentialMetabolism, Vol. 19, No. 10Thyroid gland in Graves' disease: Victim or culprit?Metabolism, Vol. 19, No. 10More about Australia Antigen and HepatitisThe Lancet, Vol. 296, No. 7668L.A.T.S.The Lancet, Vol. 296, No. 7668Stimulation of thyroid adenyl cyclase activity and cyclic adenosine 3′,5′-monophosphate by long-acting thyroid stimulatorMetabolism, Vol. 19, No. 6VI—THE THYROID GLANDThe Lancet, Vol. 295, No. 7661The nature of the interaction between thyroid stimulating γG-globulin (long-acting thyroid stimulatory) and thyroid tissueBiochimica et Biophysica Acta (BBA) - General Subjects, Vol. 208, No. 2The thyroid-stimulating properties of long-acting thyroid stimulator γG-globulin subunitsBiochimica et Biophysica Acta (BBA) - General Subjects, Vol. 192, No. 2THYROTOXICOSIS: DRUGS, SURGERY, OR RADIOIODINE?The Lancet, Vol. 294, No. 7627The distribution of the long-acting thyroid stimulator among γG-immunoglobulinsBiochimica et Biophysica Acta (BBA) - Protein Structure, Vol. 188, No. 1Iodide goiter and the pharmacologic effects of excess iodideThe American Journal of Medicine, Vol. 47, No. 1The effect of radioablation of the thyroid gland in Graves' disease with high levels of long-acting thyroid stimulator (LATS)The American Journal of Medicine, Vol. 46, No. 2EMOTION AND NON-SPECIFIC INFECTION AS POSSIBLE ÆTIOLOGICAL FACTORS IN GRAVES' DISEASEThe Lancet, Vol. 292, No. 7561LEUCOCYTE-HEXOKINASE ISOENZYMES IN DOWN'S SYNDROMEThe Lancet, Vol. 292, No. 7561 More from this issue > Volume 48Issue 1January 1968Pages 252-310 Copyright & PermissionsCopyright © 1968 by American Physiological Societyhttps://doi.org/10.1152/physrev.1968.48.1.252PubMed4865519History Published online 1 January 1968 Published in print 1 January 1968 Metrics

EXPERIMENTAL STUDY ON EXOPHTHALMOS IN HYPERTHYROIDISM: STUDIES ON THE EXOPHTHALMOS-PRODUCING SUBSTANCE

In order to obtain some information about endocrine exophthalmos, the author attempted to determine the exophthalmos producing activity of desiccated thyroid (thyradine), thyroxine (T4) and triiodothyronine (T3), to separate exopthalmos producing substance (EPS) from thyroid stimulating hormone (TSH) with column chromatography using pig thyrotropin preparation (pretiron) as the starting material and finally to test the effect of the thyroid hormone preparations on the exophthalmos producing response in gold fish, induced by pretiron.The bioassay of EPS was performed by the determination of the percent increase in intercorneal distance (ICD) in gold fish after the intracloacal injection of the materials. The bioassay of TSH was performed with Bakke-Ogura's in vitro method using the suppressive effect of TSH on the release of 131I from bovine thyroid slice. Column chromatography was performed on CM-C and DEAE-C.The following results were obtained : 1) No marked diurnal variation was observed in ICD in gold fish, and ICD was not affected by the operative procedure of cutting off the fins or intracloacal puncture.2) As the increase in ICD after the injection of 0.9% saline was under 5%, the author defined that an increase over 5% was significant. Macroscopic exophthalmos was observed at 3 hrs. after the injection of 5 Junkmann-Schoeller Units (JSU) of pretiron, and the peak of percent increase was reached at about 5 hrs.. The exophthalmic response of gold fish was decreased in summer when water temperature showed above 30°C.3) At 5 hrs. after the injection of pretiron a linear responsiveness of percent increase in ICD to graded doses of TSH was observed to be between 1.25 JSU and 10.0 JSU of pretiron, but on the other hand, at 10 hrs it was observed to be between 1.25 JSU and 5.0 JSU.4) Chromatographing pretiron on CM-C using 0.01M phosphate buffer solution for the first elution, and 1.0 M NaCl for the second, the second fraction had biologically highly thyroid stimulating and exophthalmos producing activity. Changing the elute beffer gradiently from the phosphate buffer to 1.0 M NaCl, the latter half of the second fraction also showed both thyroid stimulating and exophthalmos producing activity.5) DEAE-C, 0.005 M glycine-NaOH, 0.1 M glycine-NaOH, 0.2 M NaH2PO4 and 1.0 M NaCl were used as the elute buffer. The fractions eluted by the 1st, 2nd, 3rd and 4th buffer were named Fraction I, II, III and IV, respectively. Fraction III showed marked thyroid stimulating activity, and Fraction II, III and IV showed exophthalmos producing activity equally.6) An exophthalmic response was observed on the 4th day following the administration of a large quantity (20 mg) of thyradine, but it was not observed following the administration of T3 or T4.7) The pretreatment with T3 showed a marked, inhibiting effect on exophthalmos production by pretiron, compared with that of thyradine or T4.From the results above mentioned, it is suggested that EPS is distinct from TSH and that T3 may be used as one of the therapeutic drugs for proptosis in patients with hyperthyroidism.