Wall J R, Henderson J, Strakosch C R, Joyner D M
Can Med Assoc J. 1981 Apr 1;124(7):855-62, 866.
Graves' ophthalmopathy usually occurs in association with hyperthyroidism. Its occasional occurrence in the absence of thyroid disease suggests, however, that it may be a separate autoimmune disorder. While the evidence supporting an autoimmune pathogenesis is considerable for the ophthalmopathy, it is not so impressive as that for Graves' hyperthyroidism: orbital antibodies have not been convincingly demonstrated and autoantigens have not been identified. On the other hand, in patients with Graves' ophthalmopathy the orbital tissues and eye muscle membranes are infiltrated with lymphoid cells and show evidence of cell-mediated immune reactions. Although there is some evidence that binding of thyroid stimulating hormone fragments and thyroglobulin-antithyroglobulin immune complexes to eye muscle membranes may be important in the pathogenesis of the ophthalmopathy, this needs to be confirmed. The mechanism for the association of hyperthyroidism and ophthalmopathy is unknown, but the association likely reflects an influence of thyroid hormones on the immune system. In view of the autoimmune pathogenesis the logical treatment of Graves' ophthalmopathy appears to be immunosuppression.
格雷夫斯眼病通常与甲状腺功能亢进症相关联。然而，它偶尔也会在没有甲状腺疾病的情况下发生，这表明它可能是一种独立的自身免疫性疾病。虽然支持自身免疫发病机制的证据在眼病方面相当充分，但不如格雷夫斯甲状腺功能亢进症那么令人信服：尚未令人信服地证明眼眶抗体，也未鉴定出自身抗原。另一方面，在格雷夫斯眼病患者中，眼眶组织和眼肌膜被淋巴细胞浸润，并显示出细胞介导的免疫反应的证据。虽然有一些证据表明促甲状腺激素片段和甲状腺球蛋白 - 抗甲状腺球蛋白免疫复合物与眼肌膜的结合在眼病发病机制中可能很重要，但这需要得到证实。甲状腺功能亢进症与眼病关联的机制尚不清楚，但这种关联可能反映了甲状腺激素对免疫系统的影响。鉴于自身免疫发病机制，格雷夫斯眼病的合理治疗方法似乎是免疫抑制。
