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In mild disease, patients present with eyelid retraction. In fact, upper eyelid retraction is the most common ocular sign of Graves' orbitopathy. This finding is associated with lid lag on infraduction (Von Graefe's sign), eye globe lag on supraduction (Kocher's sign), a widened palpebral fissure during fixation (Dalrymple's sign) and an incapacity of closing the eyelids completely ...
The signs and symptoms of Graves' disease generally result from the direct and indirect effects of hyperthyroidism, although they can also be caused by other thyroidal conditions, such as Graves' ophthalmopathy, goitre and pretibial myxedema. These clinical manifestations can involve virtually every system in the body.
Signs and symptoms of hyperthyroidism may include irritability, muscle weakness, sleeping problems, a fast heartbeat, poor tolerance of heat, diarrhea and unintentional weight loss. [1] Other symptoms may include thickening of the skin on the shins, known as pretibial myxedema, and eye bulging, a condition caused by Graves' ophthalmopathy. [1]
Minor ocular (eye) signs, which may be present in any type of hyperthyroidism, are eyelid retraction ("stare"), extraocular muscle weakness, and lid-lag. [20] In hyperthyroid stare ( Dalrymple sign ) the eyelids are retracted upward more than normal (the normal position is at the superior corneoscleral limbus , where the "white" of the eye ...
Dalrymple's sign is a widened palpebral (eyelid) opening, or eyelid spasm, seen in thyrotoxicosis (as seen in Graves' disease, exophthalmic goitre and other hyperthyroid conditions), causing abnormal wideness of the palpebral fissure.
Lid lag is the static situation in which the upper eyelid is higher than normal with the globe in downgaze. [1] It is most often a sign of thyroid eye disease, but may also occur with cicatricial changes to the eyelid or congenital ptosis.
The most common type of hyperthyroidism, Graves' disease, may additionally cause eye problems (Graves' ophthalmopathy) and skin changes of the legs (pretibial myxedema). [6] Thyroid disease may also cause muscle weakness in the form of thyrotoxic myopathy, but this is constant rather than episodic. [5]
Boston's sign is the spasmodic lowering of the upper eyelid on downward rotation of the eye, indicating exophthalmic goiter. [1] Similar to von Graefe's sign, it is observed in people with Graves-Basedow disease, a type of hyperthyroidism. In this disease, the immune system attacks the thyroid gland and the soft tissues surrounding the eyes.
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