Graves Disease
Basics
Description
Autoimmune disease in which thyroid-stimulating hormone (TSH) receptor activation by thyrotropin receptor antibodies (TRAb) cause increased thyroid hormone secretion; most common cause of hyperthyroidism; classic findings are thyrotoxicosis, diffuse goiter, ophthalmopathy (orbitopathy), and occasionally localized dermopathy (pretibial myxedema).
Epidemiology
Incidence
- Annual incidence of 20 to 50 cases per 100,000 persons
- Peaks between 30 and 50 years of age
- Occurs in 0.2% of pregnancies, of which 95% is due to Graves disease
- Graves disease accounts for 60–80% of all cases of hyperthyroidism.
Prevalence
Has been reported to affect 1–1.5% of the world population
Etiology and 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 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
- Twin studies show concordance rate as high as 20%.
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, selenium, amiodarone, lithium, highly active antiretroviral therapy (HAART); rarely, immune-modulating medications (e.g., interferon therapy)
- Smoking (higher risk of developing ophthalmopathy)
- Low vitamin D levels
- Bacterial/viral infections
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
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Citation
Domino, Frank J., et al., editors. "Graves Disease." 5-Minute Clinical Consult, 33rd ed., Wolters Kluwer, 2025. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688783/all/Graves_Disease.
Graves Disease. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2025. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688783/all/Graves_Disease. Accessed November 21, 2024.
Graves Disease. (2025). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (33rd ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688783/all/Graves_Disease
Graves Disease [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2025. [cited 2024 November 21]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688783/all/Graves_Disease.
* Article titles in AMA citation format should be in sentence-case
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