Exophthalmos and Treatment of Graves' Disease

To the Editor.— The article by G winup et al (1982;247:2135) addressed an important question in the treatment of Graves' disease, but the importance of their findings is questionable.

Ethnic factors and myopia affect proptosis but were not mentioned. Many of the patients had less than 3 mm of proptosis, or class 1, which is "cosmetic or nonthreatening," but some had 3 mm or more, class 3, which is "potentially threatening and progressive." Soft-tissue, extraocular muscle, corneal, or optic nerve involvement (classes 2 and 4 through 6) were not mentioned.¹ Although exophthalmos is of great concern, progressive infiltrative ophthalmopathy can lead to severe functional impairment. In two large series, antithyroid drug treatment resulted in no substantial worsening of extraocular muscle function or visual acuity and no need for ocular surgery.^2,3 Several discrepancies appeared in the article. Proptosis was different in Fig 1 and Figs 2 through 4 at six