Graves' disease

Question 1

What is graves’ disease?

Answer 1

Autoimmune condition that is associated with circulating TSH receptor autoantibodies leading to overstimulation of the thyroid gland with excess thyroid hormone production

Question 2

What are the causes of Graves’ disease?

Answer 2

(Genetic) family history of autoimmune disorders (e.g., type 1 diabetes mellitus, Hashimoto disease, pernicious anemia, myasthenia gravis)
Associated with HLA-DR3 and HLA-B8 alleles
(Triggers) Infectious agents: Yersinia enterocolitica and Borrelia burgdorferi
Stress
Pregnancy

Question 3

What is the pathophysiology of Graves’ disease?

Answer 3

B and T cell-mediated autoimmunity → production of stimulating immunoglobulin G (IgG) against TSH-receptor → ↑ thyroid function and growth → hyperthyroidism and diffuse goiter

Question 4

What are the clinical features of Graves’ disease?

Answer 4

Triad of Graves disease
(Diffuse goiter)Smooth, uniformly enlarged goiter; Bruit may be heard
(Ophthalmopathy) Exophthalmos; Ocular motility disturbances; Lid retraction
(Dermopathy) pretibial myxedema

Question 5

How is Graves’ disease diagnosed?

Answer 5

(initial test) ↓/undetectable TSH and ↑ T3/T
(thyroid antibodies)↑ TRAbs (specific)
↑ Anti-TPO and anti-Tg (nonspecific)
(Thyroid scintigraphy) Showing diffuse uptake
(Thyroid ultrasound)

Question 6

What is the treatment for Graves’ disease?

Answer 6

(Beta-blocker) rapid control of hyperthyroidism symptoms
(Anti-thyroid drugs) carbimazole is started at 40mg
(Radioiodine treatment)