Graves Disease



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).



  • 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.

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.


  • 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

There's more to see -- the rest of this topic is available only to subscribers.