Pathogenesis of Graves’ Ophthalmopathy

  • Rebecca S. Bahn
Part of the Endocrine Updates book series (ENDO, volume 6)

Abstract

Graves’ disease is a relatively common disorder occurring primarily in women with an incidence of 1/1000 population/year (1). In addition to hyperthyroidism, 25–50% of individuals with Graves’ disease have clinical involvement of the eyes known as Graves’ ophthalmopathy (GO)(2). While some patients with GO experience only mild ocular discomfort, 3–5% of patients suffer from intense pain and inflammation with diplopia or even loss of vision. At present, GO is not preventable and therapeutic options for severe disease are limited. Recent insights into the pathogenesis of GO, reviewed here, have the potential to lead to new preventive and treatment strategies for this debilitating condition.

Keywords

Extraocular Muscle Thyrotropin Receptor Orbital Tissue Orbital Fibroblast TSHR mRNA 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Vanderpump M, Turnbridge W, French J et al. 1995 The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham Survey. Clin Endocrinol. 43:55–68.CrossRefGoogle Scholar
  2. 2.
    Bahn RS. 1995 Assessment and management of the patient with Graves’ ophthalmopathy. Endocr Pract. 1:172–178.PubMedGoogle Scholar
  3. 3.
    Forbes G, Gorman CA, Brennan MD, Gehring DG, Ilstrup DM, Earnest F. 1986 Ophthalmopathy of Graves’ disease: computerized volume measurements of the orbital fat and muscle. AJNR. 7:651–656.PubMedGoogle Scholar
  4. 4.
    Kahaly G, Forester G, Hansen C. 1998 Glycosaminoglycans in thyroid eye disease. Thyroid 8:429–432.PubMedCrossRefGoogle Scholar
  5. 5.
    Bahn RS, Heufelder AE. 1993 Mechanisms of disease: Pathogenesis of Graves’ ophthalmopathy. N Engl J Med. 329:1468–1475.PubMedCrossRefGoogle Scholar
  6. 6.
    Tallstedt L, Norberg R. 1988 Immunohistochemical staining of normal and Graves’ extraocular muscle. Invest Ophthalmol Vis Sci. 29:175–184.PubMedGoogle Scholar
  7. 7.
    Rundle FF, Pochin EE. 1973 The orbital tissues in thyrotoxicosis: a quantitative analysis relating to exophthalmos. Clin Sci. 5:51–74.Google Scholar
  8. 8.
    Peyster RG, Ginsberg F, Silber JH, Adler LP. 1986 Exophthalmos caused by excessive fat: CT volumetric analysis and differential diagnosis. AJNR. 7:35–40.Google Scholar
  9. 9.
    Heufelder AE, Bahn RS. 1993 Detection and localization of cytokine immunoreactivity in retro-ocular connective tissue in Graves’ ophthalmopathy. Eur J Clin Invest. 23: 10–17.PubMedCrossRefGoogle Scholar
  10. 10.
    Weetman AP. 1991 Thyroid-associated eye disease: pathophysiology. Lancet 338:25–28.PubMedCrossRefGoogle Scholar
  11. 11.
    DeCarli M, D’Elios MM, Mariotti S, et al. 1993 Cytolytic T cells with Th-1-like cytokine profile predominate in retroorbital lymphocytic infiltrates in Graves’ ophthalmopathy. J Clin Endocrinol Metab. 77:1120–1124.CrossRefGoogle Scholar
  12. 12.
    Yang D, Hiromatsu Y, Hoshino T, Inoue Y, Itoh K, Nonaka K. 1999 Dominant infiltration of TH 1 -type CD4+ cells at the retrobulbar space of patients with thyroid-associated ophthalmopathy. Thyroid 9:305–310.PubMedCrossRefGoogle Scholar
  13. 13.
    McLachlan SM, Prummel MF, Rapoport B. 1994 Cell-mediated or humoral immunity in Graves’ ophthalmopathy? Profiles of T-cell cytokines amplified by polymerase chain reaction from orbital tissue. J Clin Endocrinol Metab. 78:1070–1074.PubMedCrossRefGoogle Scholar
  14. 14.
    Grubeck-Loebenstein B, Trieb K, Sztankay A, Holter W, Anderl H, Wick G. 1994 Retrobulbar T cells from patients with Graves’ ophthalmopathy are CD8+ and specifically recognize autologous fibroblasts. J Clin Invest. 93:2738–2743.PubMedCrossRefGoogle Scholar
  15. 15.
    Natt N, Bahn RS. 1997 Cytokines in the evolution of Graves’ ophthalmopathy. Autoimmunity 26:129–136.PubMedCrossRefGoogle Scholar
  16. 16.
    Dinarello CA. 1991 Inflammatory cytokines: Interleukin-1 and tumor necrosis factor as effector molecules in autoimmune diseases. Curr Opin Immunol. 4:941–951.CrossRefGoogle Scholar
  17. 17.
    Smith TJ, Wang HS, Evans CH. 1995 Leukoregulin is a potent inducer of hyaluronan synthesis in cultured human orbital fibroblasts. Am J Physiol. 268:C382–C388.PubMedGoogle Scholar
  18. 18.
    Heufelder AE, Bahn RS. 1994 Modulation of orbital fibroblast proliferation by cytokines and glucocorticoid receptor agonists. Invest Ophthalmol Vis Sci. 35:120–127.PubMedGoogle Scholar
  19. 19.
    Wang HS, Cao HJ, Winn VD, et al. 1996 Leukoregulin induction of prostaglandin-endoperoxide H synthase-2 in human orbital fibroblasts. An in vitro model for connective tissue inflammation. J Biol Chem. 271:22718–22728.PubMedCrossRefGoogle Scholar
  20. 20.
    Young DA, Evans CH, Smith TJ. 1998 Leukoregulin induction of protein expression in human orbital fibroblasts: evidence for anatomical site-restricted cytokine-target cell interactions. Proc Natl Acad Sci USA. 95:8904–8909.PubMedCrossRefGoogle Scholar
  21. 21.
    Reddy L, Wang HS, Keese CR, Giaever I, Smith TJ. 1998 Assessment of rapid morphological changes associated with elevated cAMP levels in human orbital fibroblasts. Exp Cell Res. 245:360–367.PubMedCrossRefGoogle Scholar
  22. 22.
    Heufelder AE, Dutton CM, Sarkar G, Donovan KA, Bahn RS. 1993 Detection of TSH receptor RNA in cultured fibroblasts from patients with Graves’ ophthalmopathy and pretibial dermopathy. Thyroid 3:297–300.PubMedCrossRefGoogle Scholar
  23. 23.
    Feliciello A, Porcellini A, Ciullo, Bonavolonta G, Avvedimento EV, Fenzi G. 1993 Expression of thyrotropin-receptor mRNA in healthy and Graves’ retro-orbital tissue. Lancet 342:337–338.PubMedCrossRefGoogle Scholar
  24. 24.
    Mengistu M, Lukes YG, Nagy EV, Burch HB, Carr FE, Lahiri S, Burman KD. 1994 TSH receptor expression in retroocular fibroblasts. J Endocrinol Invest. 17:437–441.PubMedGoogle Scholar
  25. 25.
    Bahn RS, Dutton CM, Natt N, Joba W, Spitzweg C, Heufelder AE. 1998 Thyrotropin receptor expression in Graves’ orbital adipose/connective tissues: Potential autoantigen in Graves’ ophthalmopathy. J Clin Endocrinol Metab. 83:998–1002.PubMedCrossRefGoogle Scholar
  26. 26.
    Förster G, Otto E, Hansen C, Ochs K, Kahaly G. 1998 Analysis of orbital T cells in thyroid-associated ophthalmopathy. Clin Exp Immunol. 112:427–434.PubMedCrossRefGoogle Scholar
  27. 27.
    Costagliola S, Rodien P, Many MC, Ludgate M, Vassart G. 1998 Genetic immunization against the human thyrotropin receptor causes thyroiditis and allows production of monoclonal antibodies recognizing the native receptor. J Immunol. 160:1458–1465.PubMedGoogle Scholar
  28. 28.
    Many MC, Costagliola S, Detrout M, Denef F, Vassart G, Ludgate MC. 1999 Development of an animal model of autoimmune thyroid eye disease. J Immunol. 162:4966–4974.PubMedGoogle Scholar
  29. 29.
    Rodbell M. 1964 Metabolism of isolated fat cells. I. Effects of hormones on glucose metabolism and lipolysis. J Biol Chem. 239:375–380.PubMedGoogle Scholar
  30. 30.
    Davies TF, Teng CS, McLachlan SM, Smith BR, Hall R. 1978 Thyrotropin receptors in adipose tissue, retro-orbital tissue and lymphocytes. Mol Cell Endocrinol. 9:303–310.PubMedCrossRefGoogle Scholar
  31. 31.
    Perros P, Kendall-Taylor P. 1994 Demon tration of thyrotropin binding sites in orbital connective tissue: Possible role in the pathog nesis of thyroid-associated ophthalmopathy. J Endocrinol Invest. 17:163–170.PubMedGoogle Scholar
  32. 32.
    Kendall-Taylor P, Munro DS. 1971 The lipolytic activity of long-acting thyroid stimulator. Biochem Biophys Acta. 231:314–319.PubMedCrossRefGoogle Scholar
  33. 33.
    Iida Y, Amir, S, Ingbar SH. 1987 Stabilization, partial purification, and characterization of thyrotropin receptors in solubilized guinea pig fat cell membranes. Endocrinology 121:1627–1636.PubMedCrossRefGoogle Scholar
  34. 34.
    Roselli-Rehfuss L, Robbins LS, Cone RD. 1992 Thyrotropin receptor messenger ribonucleic acid is expressed in most brown and white adipose tissues in the guinea pig. Endocrinology 130:1857–1861.PubMedCrossRefGoogle Scholar
  35. 35..
    Haraguchi K, Shimura H, Ling Lin, Saito T, Endo T, Onaya T. 1996 Differentiation of rat preadipocytes is accompanied by expression of thyrotropin receptors. Endocrinology 137: 3200–3205.PubMedCrossRefGoogle Scholar
  36. 36.
    Mullin BR, Lee G, Ledley FD, Winand RJ, Kohn LD. 1976 Thyrotropin interactions with human fat cell membrane preparations and the finding of a soluble thyrotropin binding component. Biochem Biophys Res Comm. 69:55–62.PubMedCrossRefGoogle Scholar
  37. 37.
    Marcus C, Ehren H, Bolme P, Arner P. 1988 Regulation of lipolysis during the neonatal period: Importance of thyrotropin. J Clin Invest. 82:1793–1797.PubMedCrossRefGoogle Scholar
  38. 38.
    Janson A, Karlsson FA, Micha-Johansson G, Bolme P, Bronnegard M, Marcus C. 1995 Effects of stimulatory and inhibitory thyrotropin receptor antibodies on lipolysis in infant adipocytes. J Clin Endocrinol Metab. 80:1712–1716.PubMedCrossRefGoogle Scholar
  39. 39.
    Poznanski W, Waheed I, Van R. 1973 Human fat cell precursors. Morphologic and metabolic differentiation in culture. J Lab Invest. 29: 570–576.Google Scholar
  40. 40.
    Smas CM, Sul HS. 1995 Control of adipocyte differentiation. Biochem. 309:697–710.Google Scholar
  41. 41.
    Sorisky A, Pardasani D, Gagnon A, Smith TJ. 1996 Evidence of adipocyte differentiation in human orbital fibroblasts in primary culture. J Clin Endocrinol Metab. 81:3428–3431.PubMedCrossRefGoogle Scholar
  42. 42.
    Valyasevi RW, Erickson DZ, Harteneck DA, et al. 1999 Differentiation of human orbital preadipocyte fibroblasts induces expression of functional thyrotropin receptor. J Clin Endocrinol Metab. 84:2557–2562.PubMedCrossRefGoogle Scholar

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© Springer Science+Business Media New York 2000

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  • Rebecca S. Bahn

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