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Graves' disease

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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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 prevalences 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:

  • Girgis CM, Champion BL, Wall JR. Current concepts in graves' disease. Ther Adv Endocrinol Metab. 2011 Jun;2(3):135-44.

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