Graves Disease
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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
Incidence- Annual incidence of 20 to 50 cases per 100,000 persons (1)
- Peaks between 30 and 50 years of age, but people can be affected at any age
- Occurs in 0.2% of pregnancies, of which 95% is due to Graves disease
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
- 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.
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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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
Incidence- Annual incidence of 20 to 50 cases per 100,000 persons (1)
- Peaks between 30 and 50 years of age, but people can be affected at any age
- Occurs in 0.2% of pregnancies, of which 95% is due to Graves disease
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
- 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.
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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