Graves' disease

Graves' disease is an autoimmune disease mediated by thyroid-stimulating IgG immunoglobulins directed against the TSH receptor, resulting in hyperthyroidism.

The autoimmune process involved in Graves' disease also typically is directed to soft tissues within the orbit - this results in inflammation and swelling, with periorbital oedema, proptosis, and ophthalmoplegia (Graves' ophthalmology).

The presence of pre-tibial myxoedema in association with hyperthyroidism is diagnostic but is uncommon, occurring in about 6% of cases.

Estimated prevalence of different aspects of Graves' disease:

• hyperthyroidism and diffuse goitre - 95%
• thyroid eye disease - 50%
• pretibial myxoedema - 6%
• acropachy - 1%
• thyroid eye disease without hyperthyroidism ['Euthyroid Graves' disease'] - 5%

The natural history is one of alternating relapse and remission; less than 40% of patients have a single episode during their lifetime.

Reference:

1. Wémeau JL et al. Graves' disease: Introduction, epidemiology, endogenous and environmental pathogenic factors. Ann Endocrinol (Paris). 2018 Dec;79(6):599-607