• Clinical science

Graves disease

Summary

Graves disease is the most common cause of hyperthyroidism and often affects women. It is an autoimmune condition that is associated with circulating TSH receptor autoantibodies leading to overstimulation of the thyroid with excess thyroid hormone production. The classic clinical triad of Graves disease involves a diffuse vascular goiter, ophthalmopathy, and pretibial myxedema, although not all features may be present in a patient. The clinical diagnosis of Graves disease is confirmed via assessment of TSH and T3/T4 levels as well as through detection of thyroid antibodies (TRAbs, anti-TPO, anti-Tg). In addition, a diffuse uptake of 123I may be seen on thyroid scintigraphy. Treatment includes β-blockers to quickly alleviate symptoms, antithyroid drugs to achieve euthyroid status, and radioiodine ablation or, less commonly, near-total thyroidectomy for definitive control of the disease.

Epidemiology

  • Most common cause of hyperthyroidism in the United States
  • Incidence: ∼ 30 cases per 100,000 people per year
  • Sex: > (8:1)
  • Typical age range: 20–40 years

References:[1]

Epidemiological data refers to the US, unless otherwise specified.

Etiology

References:[1][2]

Pathophysiology

Clinical features

References:[3][4][5]

Diagnostics

The diagnosis of Graves disease is often apparent on clinical examination and is confirmed through detection of specific thyroid antibodies.

References:[3][6][1][7]

Treatment

References:[8][1]