Graves' disease is an autoimmune disorder Autoimmune Disorder Septic Arthritis characterized by the presence of circulating antibodies Antibodies Immunoglobulins (Igs), also known as antibodies, are glycoprotein molecules produced by plasma cells that act in immune responses by recognizing and binding particular antigens. The various Ig classes are IgG (the most abundant), IgM, IgE, IgD, and IgA, which differ in their biologic features, structure, target specificity, and distribution. Immunoglobulins: Types and Functions against the thyroid-stimulating hormone Thyroid-stimulating hormone A glycoprotein hormone secreted by the adenohypophysis. Thyrotropin stimulates thyroid gland by increasing the iodide transport, synthesis and release of thyroid hormones (thyroxine and triiodothyronine). Thyroid Hormones (TSH) receptors Receptors Receptors are proteins located either on the surface of or within a cell that can bind to signaling molecules known as ligands (e.g., hormones) and cause some type of response within the cell. Receptors, thereby causing the thyroid Thyroid The thyroid gland is one of the largest endocrine glands in the human body. The thyroid gland is a highly vascular, brownish-red gland located in the visceral compartment of the anterior region of the neck. Thyroid Gland: Anatomy gland to hyperfunction. Clinical features include hyperthyroidism Hyperthyroidism Hypersecretion of thyroid hormones from the thyroid gland. Elevated levels of thyroid hormones increase basal metabolic rate. Thyrotoxicosis and Hyperthyroidism (of which Graves' disease is the most common cause), orbitopathy, goiter Goiter A goiter is a chronic enlargement of the thyroid gland due to nonneoplastic growth occurring in the setting of hypothyroidism, hyperthyroidism, or euthyroidism. Morphologically, thyroid enlargement can be diffuse (smooth consistency) or nodular (uninodular or multinodular). Goiter, and dermopathy/pretibial myxedema Myxedema A condition characterized by a dry, waxy type of swelling (edema) with abnormal deposits of mucopolysaccharides in the skin and other tissues. It is caused by a deficiency of thyroid hormones. The skin becomes puffy around the eyes and on the cheeks. The face is dull and expressionless with thickened nose and lips. Edema. Manifestations reflect the muti-systemic effects of a hyperactive thyroid Thyroid The thyroid gland is one of the largest endocrine glands in the human body. The thyroid gland is a highly vascular, brownish-red gland located in the visceral compartment of the anterior region of the neck. Thyroid Gland: Anatomy, including heat Heat Inflammation intolerance, sweating, palpitations Palpitations Ebstein’s Anomaly, tremors, pretibial myxedema Myxedema A condition characterized by a dry, waxy type of swelling (edema) with abnormal deposits of mucopolysaccharides in the skin and other tissues. It is caused by a deficiency of thyroid hormones. The skin becomes puffy around the eyes and on the cheeks. The face is dull and expressionless with thickened nose and lips. Edema, and exophthalmos. Diagnosis is by thyroid Thyroid The thyroid gland is one of the largest endocrine glands in the human body. The thyroid gland is a highly vascular, brownish-red gland located in the visceral compartment of the anterior region of the neck. Thyroid Gland: Anatomy laboratory tests showing a low TSH, elevated thyroid hormones Thyroid hormones The 2 primary thyroid hormones are triiodothyronine (T3) and thyroxine (T4). These hormones are synthesized and secreted by the thyroid, and they are responsible for stimulating metabolism in most cells of the body. Their secretion is regulated primarily by thyroid-stimulating hormone (TSH), which is produced by the pituitary gland. Thyroid Hormones ( thyroxine Thyroxine The major hormone derived from the thyroid gland. Thyroxine is synthesized via the iodination of tyrosines (monoiodotyrosine) and the coupling of iodotyrosines (diiodotyrosine) in the thyroglobulin. Thyroxine is released from thyroglobulin by proteolysis and secreted into the blood. Thyroid Hormones ( T4 T4 The major hormone derived from the thyroid gland. Thyroxine is synthesized via the iodination of tyrosines (monoiodotyrosine) and the coupling of iodotyrosines (diiodotyrosine) in the thyroglobulin. Thyroxine is released from thyroglobulin by proteolysis and secreted into the blood. Thyroxine is peripherally deiodinated to form triiodothyronine which exerts a broad spectrum of stimulatory effects on cell metabolism. Thyroid Hormones) and triiodothyronine Triiodothyronine A T3 thyroid hormone normally synthesized and secreted by the thyroid gland in much smaller quantities than thyroxine (T4). Most T3 is derived from peripheral monodeiodination of T4 at the 5' position of the outer ring of the iodothyronine nucleus. The hormone finally delivered and used by the tissues is mainly t3. Thyroid Hormones ( T3 T3 A T3 thyroid hormone normally synthesized and secreted by the thyroid gland in much smaller quantities than thyroxine (T4). Most T3 is derived from peripheral monodeiodination of T4 at the 5' position of the outer ring of the iodothyronine nucleus. The hormone finally delivered and used by the tissues is mainly t3. Thyroid Hormones)) and thyrotropin-receptor antibodies Antibodies Immunoglobulins (Igs), also known as antibodies, are glycoprotein molecules produced by plasma cells that act in immune responses by recognizing and binding particular antigens. The various Ig classes are IgG (the most abundant), IgM, IgE, IgD, and IgA, which differ in their biologic features, structure, target specificity, and distribution. Immunoglobulins: Types and Functions (particularly the thyroid-stimulating immunoglobulins Immunoglobulins Immunoglobulins (Igs), also known as antibodies, are glycoprotein molecules produced by plasma cells that act in immune responses by recognizing and binding particular antigens. The various Ig classes are IgG (the most abundant), IgM, IgE, IgD, and IgA, which differ in their biologic features, structure, target specificity, and distribution. Immunoglobulins: Types and Functions subtype). If initial tests are nondiagnostic, radioactive iodine Iodine A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126. 90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. Thyroid Hormones uptake (increased uptake) and thyroid Thyroid The thyroid gland is one of the largest endocrine glands in the human body. The thyroid gland is a highly vascular, brownish-red gland located in the visceral compartment of the anterior region of the neck. Thyroid Gland: Anatomy ultrasound (diffuse thyroid Thyroid The thyroid gland is one of the largest endocrine glands in the human body. The thyroid gland is a highly vascular, brownish-red gland located in the visceral compartment of the anterior region of the neck. Thyroid Gland: Anatomy enlargement) provide diagnostic information. Treatment options include thionamides Thionamides Organic compounds containing the radical -CSNH2. Antithyroid Drugs, radioiodine ablation Radioiodine Ablation Thyrotoxicosis and Hyperthyroidism, and surgery.
Last updated: Sep 1, 2022
Graves’ disease is an autoimmune disorder Autoimmune Disorder Septic Arthritis in which antibodies Antibodies Immunoglobulins (Igs), also known as antibodies, are glycoprotein molecules produced by plasma cells that act in immune responses by recognizing and binding particular antigens. The various Ig classes are IgG (the most abundant), IgM, IgE, IgD, and IgA, which differ in their biologic features, structure, target specificity, and distribution. Immunoglobulins: Types and Functions against the thyroid-stimulating hormone Thyroid-stimulating hormone A glycoprotein hormone secreted by the adenohypophysis. Thyrotropin stimulates thyroid gland by increasing the iodide transport, synthesis and release of thyroid hormones (thyroxine and triiodothyronine). Thyroid Hormones (TSH) receptors Receptors Receptors are proteins located either on the surface of or within a cell that can bind to signaling molecules known as ligands (e.g., hormones) and cause some type of response within the cell. Receptors cause the thyroid Thyroid The thyroid gland is one of the largest endocrine glands in the human body. The thyroid gland is a highly vascular, brownish-red gland located in the visceral compartment of the anterior region of the neck. Thyroid Gland: Anatomy gland to hyperfunction. The syndrome may have the following features:
Susceptibility to Graves’ disease is considered to be a combination of multiple factors.
Risk factors:
Hypothalamus-pituitary-thyroid axis feedback loop:
When the thyroid hormones are low, the hypothalamus releases thyrotropin-releasing hormone (TRH), which triggers the pituitary gland to secrete TSH. The effect of this process is that the thyroid gland produces thyroxine (T4) and triiodothyronine (T3) (more T4 is produced, as it gets converted to T3). The increase in thyroid hormones (free or unbound T3/T4) creates a negative feedback, inhibiting TRH and TSH release.
Goiter: diffusely enlarged thyroid gland (arrow) in a 30-year-old pregnant woman
Image: “Diffusely enlarged thyroid gland” by Department of Cardiology, Dhaka Medical College Hospital, Dhaka, Bangladesh. License: CC BY 4.0The most common signs and symptoms of Graves’ disease
Image by Lecturio.Ophthalmologic effect of Graves’ disease: bilateral infiltrative thyroid-associated ophthalmopathy in a 33-year-old woman
Image: “Thyroid-associated ophthalmopathy” by Esra Şahlı and Kaan Gündüz. License: CC BY 2.5Myxedema
Image: “Myxedema” by Herbert L. Fred, MD and Hendrik A. van Dijk. License: CCC BY 2.0Graves’ orbitopathy: Contrast-enhanced axial MRI of a 2-year-old patient with Graves’ disease shows marked enhancement of extraocular muscles (arrows) of bilateral orbits.
Image: “T1 weighted fat saturated contrast enhanced axial MR” by Mustafa Kemal University School of Medicine, Department of Nuclear Medicine, Hatay, Turkey. License: CC BY 2.5Thyroid ultrasonography with Doppler in Graves’ disease: a 28-year-old woman with Graves’ disease whose ultrasound with Doppler finding shows diffuse colour flow representing intense vascularity (“thyroid inferno”)
Image: “Ultrasound of the thyroid” by Saleh Aldasouqi et al. License: CC BY 2.0Thyroid uptake scans (thyroiditis versus other thyroid diseases):
A: normal
B: Graves’ disease: diffuse increased uptake in both thyroid lobes
C: toxic multinodular goiter: “hot” and “cold” areas of uneven uptake
D: toxic adenoma: increased uptake in a single nodule with suppression of the surrounding thyroid
E: thyroiditis: decreased or absent uptake