Graves disease
Updates to Article Attributes
Graves disease (in mainland Europe it is called Basedow disease 9) is an autoimmune thyroid disease and is the most common cause of thyrotoxicosis (up to 85%).
Epidemiology
There is a strong female predilection with an F:M ratio of at least 5:1. It typically presents in middle age.
Clinical presentation
Patients are thyrotoxic. Extrathyroid manifestations include:
- cutaneous manifestations of Graves disease
- pretibial myxoedema (thyroid dermopathy): occurs in ~2% and almost associated with thyroid ophthalmopathy 7
- skeletal manifestations of Graves disease
- thyroid acropachy: occurs in ~1% 7
- Graves ophthalmopathy or orbitopathy: affects 20-25% of cases
- encephalopathy associated with autoimmune thyroid disease (EAATD) 2, 8
The combination of exophthalmos, tachycardia, and goitre is called the Merseburger Triad.
Pathology
Results from an antibody directed stimulation of the thyroid-stimulating hormone (TSH) receptor, with resultant production and release of T3 and T4.
Macroscopic appearance
The affected gland shows diffuse, symmetrical enlargement, with a fleshy red cut surface. This appearance can be altered by preoperative treatment or chronicity.
Microscopic appearance
The histological features are consistent with the activated state of the gland:
- plump follicular cells with increased amounts of eosinophilic cytoplasm
- hyperplastic follicles with papillary epithelial infoldings
- evidence of colloid reabsorption including 'scalloping' at the apical membrane and variable follicle collapse and exhaustion
These features can be altered by preoperative treatment or chronicity.
Serology
- TSH: suppressed
- T4: elevated
- T3: elevated
- thyroid receptor antibodies (TSI, TGI, TBII): positive
Radiographic features
Ultrasound
- thyroid gland is often enlarged and can be hyperechoic
- heterogeneous thyroid echotexture
- relative absence of nodularity in uncomplicated cases
- hypervascular; may demonstrate a thyroid inferno pattern on colour Doppler 1
Nuclear medicine
- 123I: imaging performed at around 2-6 days; classically demonstrates homogeneously increased activity in an enlarged gland
- 99mTcpertechnetate: homogeneously increased activity in an enlarged thyroid gland
Differential diagnosis
For hyperthyroidism consider:
- Marine-Lenhart syndrome
- toxic thyroid adenoma
- toxic multinodular goitre
- inflammatory:
- subacute thyroiditis
- postpartum thyroiditis
- silent thyroiditis
- pituitary adenoma
- extrathyroid origin
- struma ovarii
- metastatic thyroid carcinoma
- factitious hyperthyroidism
History and etymology
It is named after Robert James Graves (1796-1852),Irish surgeon, who first described it in 1835 9, and Carl Adolph von BaselowBasedow (1799-1854), German physician, who described it in 1840 10,11. The Merseburger triad was first described by Dr BaselowBasedow who practiced in Merseburg 12.
Practical points
- patients with Graves disease are at higher risk of iodinated contrast-induced thyrotoxicosis
-</ul><h4>History and etymology</h4><p>It is named after <strong>Robert James Graves </strong>(1796-1852),<strong> </strong>Irish surgeon, who first described it in 1835 <sup>9</sup>, and <strong>Carl Adolph von Baselow</strong> (1799-1854), German physician, who described it in 1840 <sup>10,11</sup>. The Merseburger triad was first described by Dr Baselow who practiced in Merseburg <sup>12</sup>.</p><h4>Practical points</h4><ul><li>patients with Graves disease are at higher risk of <a href="/articles/iodinated-contrast-induced-thyrotoxicosis">iodinated contrast-induced thyrotoxicosis</a>- +</ul><h4>History and etymology</h4><p>It is named after <strong>Robert James Graves </strong>(1796-1852),<strong> </strong>Irish surgeon, who first described it in 1835 <sup>9</sup>, and <strong>Carl Adolph von Basedow</strong> (1799-1854), German physician, who described it in 1840 <sup>10,11</sup>. The Merseburger triad was first described by Dr Basedow who practiced in Merseburg <sup>12</sup>.</p><h4>Practical points</h4><ul><li>patients with Graves disease are at higher risk of <a href="/articles/iodinated-contrast-induced-thyrotoxicosis">iodinated contrast-induced thyrotoxicosis</a>
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