Which finding is most characteristic of Graves disease?

• A. Periorbital edema
• B. Exophthalmos
• C. Hoarse voice
• D. Weight gain

Answer: (B)

Exophthalmos is the hallmark finding in Graves disease because autoimmune processes not only drive hyperthyroidism but also inflame and swell the tissues behind the eyes, pushing the eyeballs forward. This proptosis results from infiltration of extraocular muscles and retroorbital connective tissue with immune cells and glycosaminoglycans, leading to forward displacement of the eyes and possible double vision or irritation from exposure.

Periorbital edema can occur, but it isn’t as distinctive as the forward gaze outward characteristic of Graves ophthalmopathy. Weight loss is more typical due to the hypermetabolic state, and hoarseness is not a defining feature of Graves. So the most characteristic finding among these is the visible protrusion of the eyes.