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May 1990

Graves' Ophthalmopathy: Is It Really Thyroid Disease?

Author Affiliations

Department of Ophthalmology University of Southern California 1355 San Pablo St Los Angeles, CA 90033

Arch Intern Med. 1990;150(5):948-950. doi:10.1001/archinte.1990.00390170010003

The triad of hyperthyroidism, diffuse goiter, and ophthalmopathy was identified as a disease entity by Parry, 1 Graves, 2 and von Basedow3 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