- Clinical science
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.
- 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
Epidemiological data refers to the US, unless otherwise specified.
- B and T lymphocyte-mediated autoimmune disorder
- Genetic predisposition: 50% of patients with Graves disease have a family history of autoimmune disorders (e.g., type 1 diabetes mellitus, Hashimoto's disease, pernicious anemia, myasthenia gravis)
- May be triggered by surgery/trauma of the thyroid gland and possibly severe psychological stress
- TSH-receptor stimulating IgG immunoglobulin (TRAb; ) → ↑ thyroid function and growth → hyperthyroidism and diffuse goiter
- TRAb also stimulate:
- Symptoms of
Triad of Graves disease
- Smooth, uniformly enlarged goiter
- Bruit may be heard at the superior poles of the lobes
- Ophthalmopathy (see )
- Dermopathy (pretibial myxedema): non-pitting edema and firm plaques on the anterior/lateral aspects of both legs
- Diffuse goiter
The diagnosis of Graves disease is often apparent on clinical examination and is confirmed through detection of specific thyroid antibodies.
- Best initial test: ↓/undetectable TSH and ↑ T3/T4 (see “Diagnosis” in )
- Measure thyroid antibodies
- Thyroid scintigraphy
- Thyroid ultrasound (with color doppler)
- β-blockers: rapid control of hyperthyroidism symptoms
- : methimazole, propylthiouracil
- Surgery: near-total thyroidectomy is rarely done in Graves disease
- Complications of therapy
- See “Therapy” in h for more information.
- See “Graves ophthalmopathy” in orbital disorders for more information,