Ultrasonographic Evidence of a Consistent Orbital Involvement in Graves's Disease

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Abstract
B-mode ultrasonography of one or both orbits was performed in 47 patients with Graves's disease to determine whether a single mechanism is responsible for the different degrees of eye changes. According to clinical criteria, 30 patients had no or nonthreatening eye changes (Class 0 to 1), and 17 had more severe changes (Class 2 to 4). Ultrasonic changes, primarily in extraocular muscles, were minimal to moderate in 44 patients, equivocal in two and absent in only one patient. This uniform orbital involvement, even in the absence of clinical signs, favors the theory of a single and common pathologic mechanism in the thyroidal and ocular derangement in Graves's disease. Ultrasonic patterns resembling those in pseudotumor or tumor of the eye were found in eight patients with Graves's disease. In such cases misinterpretation was avoided by ultrasonography of the other eye. (N Engl J Med 290:1447–1450, 1974)

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