Which one of the following clinical signs is not seen in ophthalmic Graves’disease?
Manifestations of Graves’ disease:
1.Diffuse hyperfunctioning goiter—bruit over gland.
2. Graves’ ophthalmopathy—inflammatory infiltrate of orbital contents, exclusive of globe, with lymphocytes, mast
cells, and plasma cells.
It has two components—
(a) spastic—stare, lid lag, lid retraction,
(b) mechanical—proptosis, ophthalmoplegia, congestiveoculopathy (chemosis, conjunctivitis, periorbital swelling), corneal ulceration, optic neuritis, optic atrophy.
Dermatopathy—thickening of dermis, which is infiltrated with lymphocytes and with hydrophilic, metachromatically staining mucopolysaccharides. Dermatopathy usually occurs over dorsum of legs or feet (localized or pretibial myxedema). It is a late phenomenon but not a manifestation of hypothyroidism,
skin—thickened, Peau d’orange appearance, pruritic, hyperpigmented, nonpitting edema, and thyroid acropathy (clubbing of fingers and toes with bony changes may accompany the dermal changes).
Lid retraction
Frequent blinking
Poor convergence
Upper lid “lag” on down gaze