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Graves Disease

Graves Disease is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

Autoimmune disease in which thyroid-stimulating antibodies cause increased thyroid function; most common cause of hyperthyroidism. Classic findings are goiter, ophthalmopathy (orbitopathy), and occasionally dermopathy (pretibial or localized myxedema).

Epidemiology

Prevalence
  • Overall prevalence of hyperthyroidism in United States: ~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.
  • Hyperthyroidism occurs in 0.2% of pregnancies, of which 95% is due to Graves disease.
  • Predominant age: 30 to 40 years
  • Synonym(s): Basedow disease

Etiology and Pathophysiology

  • Excessive production of thyroid-stimulating hormone (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 activates the receptor, stimulating thyroid hormone synthesis and secretion as well as thyroid growth (leading to goiter).
  • Binding to similar antigen in retro-orbital connective tissue causes ocular symptoms.

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

Risk Factors

  • Female gender (5 to 10 times more than men)
  • Postpartum period
  • Family history (15% of patients with Graves disease have an affected relative)
  • Medications: iodine, amiodarone, lithium, highly active antiretroviral (HAART); rarely, immune-modulating medications (e.g., interferon therapy)
  • Smoking (higher risk of developing ophthalmopathy)

General Prevention

Screening 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.

Commonly Associated Conditions

  • Mitral valve prolapse
  • Type 1 diabetes mellitus
  • Addison disease, hypokalemic periodic paralysis
  • Vitiligo, alopecia areata
  • Other autoimmune disorders (myasthenia gravis, celiac disease)

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Citation

Stephens, Mark B., et al., editors. "Graves Disease." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. 5minute, www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/117287/all/Graves_Disease.
Graves Disease. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/117287/all/Graves_Disease. Accessed May 27, 2019.
Graves Disease. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/117287/all/Graves_Disease
Graves Disease [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 May 27]. Available from: https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/117287/all/Graves_Disease.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Graves Disease ID - 117287 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/117287/all/Graves_Disease PB - Wolters Kluwer ET - 27 DB - 5minute DP - Unbound Medicine ER -