Graves’ Ophthalmopathy: the Role of Cytokines in Pathogenesis
The clinical triad of goiter, rapid heart rate, and eye disease was first described in the early 19th century. This form of hyperthyroidism is commonly called Graves’ disease, and the associated eye condition is referred to as Graves’ ophthalmopathy (GO), thyroid ophthalmopathy, or endocrine ophthalmopathy. GO is clinically evident in 25 to 50% of patients with Graves’ hyperthyroidism and pretibial dermopathy is diagnosed in a small percentage of patients with GO. Cytokines are produced by a variety of different cell types and act on nearly every tissue and organ system in the body. Cytokines are an important effector link in GO between the autoimmune process and the connective tissue manifestations of the disease. Interactions between particular cytokines and fibroblasts in the orbit and skin, resulting in alterations of particular fibroblast biosynthetic and immunologic properties, appear to be important in the development and propagation of the orbital and dermal pathology.