Graves' disease (diffuse toxic goiter) is an autoimmune condition and the most common cause of hyperthyroidism. The immune system produces antibodies that stimulate the thyroid gland to overproduce hormones.
It mainly affects women (7–8 times more often than men). A distinctive feature is possible eye involvement (thyroid eye disease).
Mechanism
The immune system produces antibodies to the TSH receptor (TRAb, thyroid-stimulating immunoglobulins). They bind to the receptors on the gland's cells and, like TSH, make it continuously produce hormones — but without normal feedback. As a result, hormone levels rise and the body's own TSH is suppressed.
Symptoms and the eyes
The manifestations of hyperthyroidism: palpitations, tremor, insomnia, weight loss, muscle weakness, heat intolerance. In about a third of patients thyroid eye disease develops — redness, "bulging" of the eyes, double vision; smoking markedly worsens its course. Rarely a thickening of the skin on the shins occurs (pretibial myxedema).
Diagnosis
In the blood — a low TSH and elevated free T4 and free T3. The specific marker is antibodies to the TSH receptor (TRAb); a positive result confirms the diagnosis. Ultrasound and scintigraphy (diffusely increased iodine uptake) complete the picture.
Treatment
The options are the same as for hyperthyroidism: antithyroid drugs, radioactive iodine and thyroidectomy. After radioiodine or surgery, hypothyroidism usually develops, with lifelong replacement therapy. Eye disease is treated separately; the key self-help measure is quitting smoking.
Calculate using this marker
Calculators where Graves' disease is used directly:
Frequently asked questions
How does Graves' disease differ from other causes of hyperthyroidism?
In Graves', the whole gland is diffusely stimulated by antibodies to the TSH receptor, whereas in a toxic nodule the hormone is produced by autonomous nodules, and in thyroiditis it is a temporary "leak" of stored hormone. They are told apart by TRAb, ultrasound and scintigraphy.
Do the eye symptoms go away?
Mild eye disease often stabilizes or improves, especially with smoking cessation and normalization of gland function. Severe forms require treatment by an ophthalmologist and an endocrinologist.