Can endocrine exophthalmos now be viewed as separate from thyroid autoimmunity?

J. R. Wall, J. How, M. Salvi, Y. Hiromatsu

Research output: Contribution to journalArticlepeer-review


The immunological abnormalities demonstrated in patients with Graves' ophthalmopathy are discussed in the context of the disease's close association with autoimmune thyroid disorders. Evidence is presented for the existence of eye muscle autoantibodies including those which are cytotoxic to eye muscle cells in vitro in antibody-dependent cell-mediated cytotoxicity. In some cytotoxic antibodies cross-react with surface antigens on orbital fibroblasts and thyroid cells. The demonstration of cross-reactivity of anti-thyroglobulin autoantibodies, in patients with autoimmune thyroid disorders with or without eye disease, with orbital connective tissue membranes provides a model for thyroid-orbital tissue cross-reactivity. There is also evidence for cell-mediated immunity against eye muscle soluble and orbital connective tissue membrane antigens, and correlation between eye muscle antibody levels and level of cell-mediated reactivity assessed as leukocyte procoagulant against crude activity and soluble affinity purified eye muscle antigens. Graves' ophthalmopathy may always occur either with or after autoimmune thyroid disorders. Although there is evidence for B and T cell reactivity against specific eye muscle autoantigens the primary event in 'Graves' disease' may be reactivity of cytotoxic antibodies, and perhaps helper and cytotoxic T cells, against thyroid cell surface antigens, with secondary reaction against eye muscle/thyroid shared antigens, and the development of ophthalmopathy. This occurs in the context of cell surface Class II MHC (HLA) antigen expression on eye muscle and thyroid cells and interferon production by activated T cells. The thyroid and orbital inflammatory reactions are thus considered to be closely associated, Graves' ophthalmopathy and autoimmune thyroid disorders being components of a 'restricted multiple system disease'.

Original languageEnglish
Pages (from-to)141-163
Number of pages23
JournalBailliere's Clinical Immunology and Allergy
Issue number1
Publication statusPublished - 1987

ASJC Scopus subject areas

  • Immunology and Microbiology(all)


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