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Hashimoto’s Thyroiditis and Graves’ Disease With Exophthalmos Without Hyperthyroidism

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Abstract

GRAVES’ disease, in its classic form, is usually characterized by hypertrophy and hyperplasia of the thyroid, hyperthyroidism, and a specific type of ophthalmopathy.1 It is well known that hyperthyroidism may exist without ophthalmopathy. The converse of this, although less well known, also exists; namely, the presence of this unique type of ophthalmopathy without hyperthyroidism. (No hyperthyroidism has developed in many such patients whose progress has been followed for several years.) From a standpoint of test procedures, patients with ophthalmopathy without hyperthyroidism resemble patients with typical Graves’ disease. They frequently resist the suppressive influence of thyroid hormone on the uptake of I131 by the thyroid.2 In addition, Liddle, Heyssel, and McKenzie3 found a long-acting thyroid stimulator (LATS) in the sera of five patients with ophthalmopathy without hyperthyroidism. Thus, it would seem that patients with this unique type of opthalmopathy without hyper-thyroidism have the same basic disease process as patients with typical Graves’ disease.

The association of Hashimoto’s (lymphocytic) thyroiditis with hyperthyroidism due to Graves’ disease, with or without ocular signs has been reported to have occurred in about 5 percent of patients.4–9 The characteristic pathologic findings that were observed, in addition to various degrees of oxyphilia of the cytoplasm of the thyroid cells, included lymphocytic and plasma-cell infiltration, and fibrosis. (These changes are essentially the same as those reported to occur in previously euthyroid patients who had Hashimoto’s thyroiditis without Graves’ disease.) In such patients, the incidence of hypothyroidism after subtotal thyroidectomy has been high, ranging from 29 to 67. . .


 

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