Gravesian ophthalmopathy was described first by Means.1 His classification of subtypes of Graves' disease ranges from no ophthalmopathy and severe hyperthyroidism to severe infiltrative ophthalmopathy and minimal hyperthyroidism.
Ten euthyroid patients with the early eye signs of Graves' disease have been described by Werner.2 Some of these patients were actually in the early stages of hyperthyroidism, while others remained euthyroid during prolonged follow-up. In a more recent attempt to explain why hyperthyroidism does not develop, Liddle studied five patients with infiltrative ophthalmopathy and euthyroidism.3 All showed a failure to respond to thyroid stimulating hormone (TSH). It was concluded that hyperthyroidism did not develop because of a limited thyroid reserve, due to some prior insult to the gland.
We are reporting five patients with Graves' disease without hyperthyroidism, four of whom responded normally to exogenous TSH.
Materials and Methods
Five patients were studied in the Nuclear Medicine Laboratory