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November 1956

Endocrine Aspects of Exophthalmos

Author Affiliations

Professor of Clinical Medicine, School of Medicine, University of Pennsylvania; Chief, Endocrine Section, Medical Clinic, Hospital of the University of Pennsylvania.

AMA Arch Ophthalmol. 1956;56(5):668-670. doi:10.1001/archopht.1956.00930040676003

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 Mulvany1 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;