Orbital Decompression for Graves' Ophthalmopathy

Graves' disease is an autoimmune process with an antibody directed against the TSH receptor. Graves' hyperthyroidism results from stimulation of the thyrotropin receptors on thyroid follicular cells by circulating thyrotropin receptor antibodies. Graves' disease, when fully expressed, consists of hyperthyroidism, pretibial dermopathy, and ophthalmopathy. A likely scenario for ophthalmopathy might be as follows. Preadipocyte fibroblasts within the orbit may be stimulated in the setting of Graves' disease to differentiate into mature adipocytes that express TSH receptors. Factors responsible for this stimulation are unknown, but are likely disease-specific.