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Thyroid-associated ophthalmopathy (TAO) is a common orbital disease in the adults, and glycosaminoglycan deposits in the periorbital connective tissue is one of important pathological features.Hyaluronic acid is the main component of glycosaminoglycan, which is extremely hydrophilic and viscoelastic, so that it is capable of binding many times its volume in water.Consequently, the extraocular muscle and adipose connective tissue become edematous and fibrotic, which may leads to the clinical symptoms of TAO.Orbital fibroblasts are main source of hyaluronic acid and they can express insulin-like grow factor-1 receptor, thyroid stimulating hormone receptor and other cytokine receptors.Autoantibodies and many cytokines can bind those receptors to promot the synthesis of hyaluronic acid under the existing of hyaluronan synthase, which may leads to an increase of hyaluronic acid concentration in periorbital tissue, peripheral blood and body fluid, and provide the basis on the diagnosis, activity assessment and therapeutic evaluation.