Thyroid

Grave's Disease

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Grave's Disease, Basedows Disease, Exophthalmic Goiter, Graves Disease, Graves Dermopathy

  • See Also
  1. Thyroid Eye Disease
  2. Hyperthyroidism
  • Epidemiology
  1. Most common cause of Thyrotoxicosis in the United States (up to 60-80% of cases)
  2. Prevalence: 20 to 50 in 100,000
  3. Gender: More common in women
  • Pathophysiology
  1. Autoimmune disorder
  2. Thyroid stimulating antibodies bind TSH receptors, resulting in Thyroid Hormone synthesis and release
  3. Associated with Thyroid Gland hyperplasia and Goiter
  • Risk Factors
  1. Female gender
  2. Autoimmune Disorder
  3. Family History of Graves Disease (or other autoimmune disorder)
  4. Tobacco Abuse
  5. Iodine exposure
  • Findings
  1. See Hyperthyroidism
  2. Older patients may present less specifically (e.g. Fatigue, weight loss, Atrial Fibrillation)
  • Signs
  • Specific to Grave's Disease
  1. See Hyperthyroidism
  2. Diffuse, smooth Goiter
    1. Palpated thrill or audible bruit over Thyroid
  3. Infiltrative ophthalmopathy or orbitopathy (Thyroid Eye Disease)
    1. Ophthalmoplegia
    2. Proptosis (Exophthalmos) in 25-50% of cases
    3. Periorbital swelling
  4. Dermopathy
    1. Pretibial Myxedema (Thyroid dermopathy, 1.5% of cases)
      1. Swelling over the tibia
      2. Peau d' orange skin changes
    2. Thyroid Acropachy
      1. Hand soft tissue swelling and Digital Clubbing
    3. Skin Pigment Changes
      1. Patchy Hyperpigmentation or vitilgo
  • Differential Diagnosis
  1. See Hyperthyroidism
  • Labs
  1. See Hyperthyroidism
  2. Thyroid Stimulating Immunoglobulin (TSH receptor ab)
    1. Specific to Grave's Disease
    2. Linked with ophthalmopathy
    3. Usually not needed for diagnosis
    4. May be used to monitor effects of treatment
  3. Antithyroid Peroxidase Antibody negative
    1. Contrast with positive in Hashimoto's Thyroiditis
  • Imaging
  1. Thyroid uptake and scan (first-line study)
    1. Diffusely high Radioactive Iodine uptake
  2. Thyroid Ultrasound with doppler (if performed)
    1. Thyroid hypervascularity with increased flow
  • Management
  1. See Hyperthyroidism Management
  2. Referral to ophthalmology for ocular involvement
  • References
  1. Humphrey (2024) Am Fam Physician 109(6): 567-8 [PubMed]
  2. Kravets (2016) Am Fam Physician 93(5): 363-70 [PubMed]