Retroocular and pretibial fibroblasts are likely important effector cells in Graves' ophthalmopathy and pretibial dermopathy. Histologic similarities exist between the tissues involved in these clinically diverse extrathyroidal manifestations of Graves' disease. Both conditions are characterized by an accumulation of glycosaminoglycans (GAGs) and an infiltration of lymphocytes. We have shown that particular cytokines, probably released by the local inflammatory cell infiltrate, are capable of stimulating GAG synthesis by retroocular and pretibial fibroblasts. In order to explain the site-selective involvement of these anatomically distinct areas in Graves' disease, we sought to identify unique characteristics shared by retroocular and pretibial fibroblasts. We have shown that affected retroocular and pretibial fibroblasts demonstrate an enhanced HLA-DR response to interferon-gamma treatment and that retroocular fibroblasts are especially sensitive to the GAG-stimulating effect of this cytokine. In addition, we have shown that only affected retroocular and pretibial fibroblasts express the 72 kDa heat shock protein. Therefore, affected retroocular and pretibial fibroblasts possess unique immunologic features that may render them more susceptible to the autoimmune process in Graves' disease. Chronic stimulation of fibroblasts by cytokines released in the local inflammatory milieu may result in excessive GAG production by these cells. The accumulation of these hydrophilic mucopolysaccharides, with attendant edema, leads to the clinical manifestations of Graves' ophthalmopathy and pretibial dermopathy.