Acute endocrine ophthalmopathy in a 12-year-old boy with long-acting thyroid stimulator.

The aetiology of ophthalmopathy associated with thyroid disease is unknown. Excessive secretion of pituitary thyrotropin (TSH) had been suggested as a cause of exophthalmos (thyrotropic) (Falconer and Alexander, 195I). However, assays for thyrotropic hormone in patients with endocrine ophthalmopathy failed to reveal an elevation of TSH in the blood either before or during the development of acute ophthalmopathy (Utiger, I965; Odell, Wilber, and Paul, I965; Kriss, Pleshakov, Rosenbloom, Holderness, Sharp, and Utiger, I967). Adams and Purves (1956) described a new long-acting thyroid stimulator (LATS). Kriss and others (I967) found that endocrine ophthalmopathy and pretibial myxoedema correlated with the level of LATS. LATS differs from TSH in that its peak action of thyroid stimulation occurs 8 to 9 hours after its introduction into experimental animals, it has a longer biological half-life, and is not found in the pituitary gland. LATS is a 7S gamma2 globulin, suggesting an antibody (Kriss, Pleshakov, and Chien, I964; Sunshine, Kusumoto, Kriss, Pleshakov, and Chien, I965; McKenzie, I965; Kriss and others, I967). Acute endocrine ophthalmopathy is unusual in children. The case is reported of a I2-year-old Negro boy who developed acute ophthalmopathy accompanied by a high level of circulating LATS.