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The patient was a man of 49 age, entered this clinic, complaining of exophthalmos, palpebral edema and arrhythmia. Palpebral fissura was r. 12mm and I.14mm and Grade of exophtha-Imos (according to Herter's exophthalmometer) was r. 18mm and I. 20mm. Graefe's sign was ±. Stellwag's sign, Möbius's sign, Jellineck's sign, Rosenbach's sign and Riesman's sign were all negative. No struma was observed. Blood analysis showed no abnormality and protein bound iodine was 12 r per ml, (normal value from 7 to 8 r per ml.), increased slightly. Radiogram of sella turcica and orbita was normal. Initial pressur of liquor cerebrospinalis was 180mm H2O slightly increased, but in other point normal. Liver function was normal except disturbance of carbohydrate disposal. Pharmacodynamic examination showed negative to epinephrine, _??_ to pilocarpin and + to atropine, that is in vagotonic state. Both urinary 17-ketosteroid and Thorn's test were normal. Vakat index was about two times in blood and about three times in urine as normal value. Basal metabolie rate (according to Holden's method) was +38%. Renal function was normal and analysis of gastric juice showed hyperacidity. In ecg. we noted right axis deviation and ventricular extrasystole.
From the presence of slight increase of protin bound iodine, vago-sympathic lability, elevation of B. M. R., exophthalmos of severe degree and in addition no struma, we diagnosed this disease as an atypical Graves' Disease, that is, Mean's “Hyperophthalmopathic Graves' Disease” and added its etiologic consideration,
