Lid lag is a feature most commonly seen in which thyroid condition?

Lid lag is a feature most commonly seen in which thyroid condition?

• A. Toxic multinodular goiter
• B. Toxic adenoma
• C. TSH-secreting pituitary adenoma
• D. Graves disease

Answer: (D)

Lid lag on downward gaze is a classic sign of Graves disease. In Graves, autoimmune processes not only stimulate the thyroid but also cause orbitopathy with inflammation and enlargement of the extraocular muscles and orbital tissues. This orbital involvement pulls the eyelids into a retracted position and makes the upper lid lag behind the globe as the gaze shifts, producing the characteristic lid lag (Von Graefe sign). Other hyperthyroid conditions, like toxic multinodular goiter or a toxic adenoma, cause thyrotoxicosis but lack the autoimmune orbital involvement that leads to lid retraction and lid lag. A TSH-secreting pituitary adenoma can cause thyrotoxicosis without the Graves-related eye signs.

Lid lag on downward gaze is a classic sign of Graves disease. In Graves, autoimmune processes not only stimulate the thyroid but also cause orbitopathy with inflammation and enlargement of the extraocular muscles and orbital tissues. This orbital involvement pulls the eyelids into a retracted position and makes the upper lid lag behind the globe as the gaze shifts, producing the characteristic lid lag (Von Graefe sign). Other hyperthyroid conditions, like toxic multinodular goiter or a toxic adenoma, cause thyrotoxicosis but lack the autoimmune orbital involvement that leads to lid retraction and lid lag. A TSH-secreting pituitary adenoma can cause thyrotoxicosis without the Graves-related eye signs.