Serum thyroglobulin, its autoantibody and thyroid stimulating antibodies in the endocrine exophthalmos

Serum concentrations of thyroglobulin, its antibody, and thyroid stimulating antibodies were studied in 32 patients referred to a department of eye-diseases for exophthalmos. Twenty-three of the patients were or had been medically treated for Graves' disease, one had toxic nodular goitre, one subclinical myxoedema, three euthyroid exophthalmos and four were shown to have non-endocrine eye-disease. In patients with medically treated Graves' disease serum thyroglobulin was significantly elevated (P < 0.02), the still toxic patients accounting for the highest values. Both thyroid stimulating and thyroglobulin antibodies were detectable in 4 of 18 patients. The rest of the patients had normal concentrations of thyroglobulin and undetectable thyroid stimulating antibodies, but 3 patients had measurable thyroglobulin antibodies. In Graves' patients there was no correlation between serum concentrations of thyroid stimulating antibodies and thyroglobulin, and no clear difference between the frequency of thyroid stimulating or thyroglobulin antibodies in the patients with persistent elevation of circulating thyroid hormones and those remaining euthyroid. A relation between the thyroid autoantibodies, thyroglobulin and the thyroid hormonal level or severity of the exophthalmic state could not be demonstrated. It is suggested that hyperthyroidism and exophthalmos are separate disorders, and immunological phenomena probably involved in the pathogenesis of exophthalmos associated with Graves' disease appear to be reflected only locally.