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ULY CLINIC

25 Septemba 2025, 01:36:42

Jellinek’s sign

Jellinek’s sign (also known as Rasin’s sign) refers to brownish pigmentation on the eyelids, typically more prominent on the upper eyelid than the lower. This cutaneous change is observed in patients with Graves’ disease, reflecting underlying autoimmune thyroid dysfunction.

Pathophysiology

Graves’ disease is an autoimmune hyperthyroidism caused by thyroid-stimulating immunoglobulins activating the thyroid gland.
Chronic thyroid hormone excess can lead to dermal melanocyte stimulation, causing localized pigmentation changes.
Eyelid skin, being thin and highly vascular, is particularly susceptible to this pigmentation.
The pigmentation may coincide with other ocular manifestations of Graves’ disease, such as exophthalmos, lid retraction, and periorbital edema.

Examination Technique

Patient positioning: Have the patient sit comfortably with eyes open and relaxed.
Inspection: Examine both upper and lower eyelids in good lighting.
Documentation: Note the distribution, intensity, and symmetry of pigmentation. Compare with surrounding facial skin.
Additional assessment: Evaluate for associated ophthalmopathy, including lid lag, retraction, and proptosis.

Clinical Features

Feature	Manifestation
Eyelid pigmentation	Brownish discoloration, more prominent on upper eyelids
Laterality	Usually bilateral but may be asymmetric
Associated ocular signs	Lid retraction, lid lag, proptosis (Graves’ ophthalmopathy)
Systemic association	Symptoms of hyperthyroidism: tachycardia, weight loss, tremors, heat intolerance

Differential Diagnosis

Condition	Key Feature	Notes
Graves’ disease	Brown eyelid pigmentation + hyperthyroid signs	Classic autoimmune hyperthyroidism
Addison’s disease	Generalized hyperpigmentation	Often includes buccal mucosa and palmar creases
Chronic sun exposure	Localized pigmentation	Usually photodistributed; no systemic symptoms
Dermal melanocytosis	Blue-gray or slate pigmentation	Congenital or acquired; not associated with thyroid disease

Pediatric considerations

Rare in children, as Graves’ disease is uncommon but can occur.
Pigmentation may be subtle and requires careful inspection.

Geriatric considerations

May be less noticeable due to age-related skin changes.
Consider differential diagnoses such as solar lentigines or drug-induced pigmentation.

Limitations

Pigmentation may be subtle or masked by skin tone.
Not specific for Graves’ disease; must correlate with other clinical and laboratory findings.

Patient counseling

Explain that the pigmentation reflects thyroid-related changes and is part of the autoimmune process.
Reassure that treatment of underlying hyperthyroidism may stabilize but not necessarily reverse pigmentation.
Advise regular follow-up with an endocrinologist for monitoring thyroid function and ocular health.

Conclusion

Jellinek’s sign is a clinical indicator of eyelid pigmentation often associated with Graves’ disease. It serves as a visible cue for underlying thyroid dysfunction and should prompt evaluation for systemic and ocular features of hyperthyroidism.

References

Bahn RS, et al. Hyperthyroidism and Other Causes of Thyrotoxicosis: Management Guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Thyroid. 2011;21(6):593–646.
Wiersinga WM. Graves’ Ophthalmopathy: Pathophysiology, Natural History, and Treatment. Thyroid. 2012;22(6):615–625.
Ross DS, et al. Diagnosis and Management of Hyperthyroidism in Adults: A Clinical Review. JAMA. 2016;316(10):1047–1058.
Bahn RS. Clinical Review: Graves’ Ophthalmopathy. N Engl J Med. 2010;362:726–738.