Description

An autoimmune disease in which thyroid-stimulating antibodies cause increased thyroid function. It is the most common cause of hyperthyroidism. Classic findings are goiter and ophthalmopathy (orbitopathy). Known as Basedow's disease in Europe.

Epidemiology

• Overall prevalence of hyperthyroidism in the US is estimated to be 2% for women and 0.2% for men.
• More common in white and Hispanic populations in comparison to the black population.
• Graves disease accounts for 60–80% of all cases of hyperthyroidism.
• Predominant age: 30–40 years

Risk Factors

• Female gender
• Postpartum period
• Stressful life events
• Medications: Iodine, amiodarone, lithium, highly active antiretroviral (HAART); rarely, immune-modulating medications (i.e., interferon therapy)
• Smoking (higher risk of developing ophthalmopathy)

Genetics
Higher risk with personal or family history of any autoimmune disease, especially Hashimoto thyroiditis

General Prevention

Screening thyroid-stimulating hormone (TSH) in asymptomatic patients is not recommended. No data conclusively show that treatment of subclinical thyroid dysfunction improves quality of life or clinical outcome measures (1)[A].

Pathophysiology

• Excessive production of TSH receptor antibodies from B cells primarily within the thyroid, likely due to genetic clonal lack of suppressor T cells
• Binding of these antibodies to TSH receptors in the thyroid causes increased production of thyroid hormone.
• Binding to similar antigen in retro-orbital connective tissue causes ocular symptoms.

Commonly Associated Conditions

• Mitral valve prolapse
• Hypokalemic periodic paralysis