Graves' disease

Graves’ disease is the most common cause of hyperthyroidism in countries with sufficient iodine intake.

Caused by thyroid-stimulating hormone (TSH) receptor antibodies.

Extrathyroidal manifestations can include orbitopathy, pretibial myxoedema (thyroid dermopathy), and acropachy, which do not occur with other causes of hyperthyroidism.

Diagnosis is mostly clinical. The combination of elevated TSH receptor antibodies (or elevated radioactive iodine/technetium-99 uptake by the thyroid if TSH receptor antibody testing is unavailable or diagnosis is uncertain); suppressed TSH; and elevated levels of circulating thyroid hormones (free T4 and total or free T3) is the standard for diagnosis of Graves' hyperthyroidism.

Treatment options are antithyroid drugs, radioactive iodine therapy, and thyroid surgery.

Untreated hyperthyroidism, particularly in older people, may result in cardiac arrhythmias, high-output cardiac failure, bone mineral loss, and, rarely, thyroid storm.

Unusual complications include vision loss secondary to orbitopathy or elephantiasis secondary to dermopathy.

Graves' disease is an autoimmune thyroid condition associated with hyperthyroidism. Associated orbitopathy occurs in around 25% of cases and is usually mild.[1]Tanda ML, Piantanida E, Liparulo L, et al. Prevalence and natural history of Graves' orbitopathy in a large series of patients with newly diagnosed graves' hyperthyroidism seen at a single center. J Clin Endocrinol Metab. 2013 Apr;98(4):1443-9. https://academic.oup.com/jcem/article/98/4/1443/2536784 http://www.ncbi.nlm.nih.gov/pubmed/23408569?tool=bestpractice.com Associated dermopathy and acropachy are rare, and almost always seen with orbitopathy.[2]Smith TJ, Hegedüs L. Graves' disease. N Engl J Med. 2016 Oct 20;375(16):1552-65. http://www.ncbi.nlm.nih.gov/pubmed/27797318?tool=bestpractice.com Thyroid-stimulating hormone (TSH) receptor antibodies cause the hyperthyroid syndrome and underlie the extrathyroidal manifestations.[3]Davies TF, Andersen S, Latif R, et al. Graves' disease. Nat Rev Dis Primers. 2020 Jul 2;6(1):52. https://www.doi.org/10.1038/s41572-020-0184-y http://www.ncbi.nlm.nih.gov/pubmed/32616746?tool=bestpractice.com Diagnosis is mostly clinical and is usually confirmed by laboratory evidence of thyroid dysfunction, most commonly hyperthyroidism and the presence of circulating TSH receptor antibodies.[2]Smith TJ, Hegedüs L. Graves' disease. N Engl J Med. 2016 Oct 20;375(16):1552-65. http://www.ncbi.nlm.nih.gov/pubmed/27797318?tool=bestpractice.com