clinically evident in 25-50% of patients with Graves' hyperthyroidism - occurs occasionally in patients with Hashimoto's thyroiditis and in those with Graves' disease but no evident thyroid disease.
the mean age is 45 years and the female:male ratio is 2:1
there is an association with cigarette smoking, as 90% of cases occur in smokers
return to normal thyroid function is associated with improvement in the eye disease
association with HLA-DR3
Graves' hyperthyroidism and Graves' ophthalmology are overlapping, if not concurrent, conditions - many patients with Graves' hyperthyroidism but no clinical eye features can be shown to have evidence of ophthalmological changes with techniques such as orbital MRI - similarly many euthyroid patients with Graves' ophthalmology can be shown to have laboratory evidence of thyroid autoimmune disease.
in 85% of patients affected by either Graves' hyperthyroidism or Graves' ophthalmology, the other develops within 18 months.
Reference:
1) Shine B et al (1990).Association between Graves' ophthalmology and cigarette smoking. Lancet, 335, 1261-3.
2) Tallstedt L et al (1992).Occurence of ophthalmology after treatment of Graves' hyperthyroidism.NEJM, 326, 1733-8.
3) Epstein FH (1993).Pathogenesis of Grave's ophthalmology. NEJM, 329(20),1468-75.
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