Grave's Disease

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

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II. 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

III. 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

IV. Risk Factors

  1. Female gender
  2. Autoimmune Disorder
  3. Family History of Graves Disease (or other autoimmune disorder)
  4. Tobacco Abuse
  5. Iodine exposure

V. Findings

  1. See Hyperthyroidism
  2. Older patients may present less specifically (e.g. Fatigue, weight loss, Atrial Fibrillation)

VI. 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

VII. Differential Diagnosis

  1. See Hyperthyroidism

VIII. 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

IX. 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

X. Management

  1. See Hyperthyroidism Management
  2. Referral to ophthalmology for ocular involvement

XI. References

  1. Humphrey (2024) Am Fam Physician 109(6): 567-8 [PubMed]
  2. Kravets (2016) Am Fam Physician 93(5): 363-70 [PubMed]

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Related Studies

Ontology: Graves Disease (C0018213)

Definition (CHV) a condition usually caused by excessive production of thyroid hormone and characterized by an enlarged thyroid gland
Definition (CHV) a condition usually caused by excessive production of thyroid hormone and characterized by an enlarged thyroid gland
Definition (CHV) a condition usually caused by excessive production of thyroid hormone and characterized by an enlarged thyroid gland
Definition (CHV) a condition usually caused by excessive production of thyroid hormone and characterized by an enlarged thyroid gland
Definition (CHV) a condition usually caused by excessive production of thyroid hormone and characterized by an enlarged thyroid gland
Definition (CHV) a condition usually caused by excessive production of thyroid hormone and characterized by an enlarged thyroid gland
Definition (CHV) a condition usually caused by excessive production of thyroid hormone and characterized by an enlarged thyroid gland
Definition (CHV) a condition usually caused by excessive production of thyroid hormone and characterized by an enlarged thyroid gland
Definition (CHV) a condition usually caused by excessive production of thyroid hormone and characterized by an enlarged thyroid gland
Definition (MSHCZE) Nejčastější příčina zvýšené funkce štítné žlázy, hypertyreózy. (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ )
Definition (NCI) Hyperthyroidism associated with diffuse hyperplasia of the thyroid gland (goiter), resulting from production of antibodies that are directed against the thyrotropin receptor complex of the follicular epithelial cells. As a result, the thyroid gland enlarges and secrets increased amounts of thyroid hormones.
Definition (CSP) exophthalmos occurring in association with goiter; hyperthyroidism with protrusion of the eyeballs.
Definition (MSH) A common form of hyperthyroidism with a diffuse hyperplastic GOITER. It is an autoimmune disorder that produces antibodies against the THYROID STIMULATING HORMONE RECEPTOR. These autoantibodies activate the TSH receptor, thereby stimulating the THYROID GLAND and hypersecretion of THYROID HORMONES. These autoantibodies can also affect the eyes (GRAVES OPHTHALMOPATHY) and the skin (Graves dermopathy).
Concepts Disease or Syndrome (T047)
MSH D006111
ICD10 E05.0
SnomedCT 367367004, 353295004, 154655004, 237823003, 267464006, 190240002, 367449005, 237510004, 55807009, 38591003
LNC LA14302-6
English Basedow Disease, Basedow's Disease, Basedows Disease, Disease, Basedow, Exophthalmic Goiter, Exophthalmic Goiters, Goiter, Exophthalmic, Goiters, Exophthalmic, Disease, Basedow's, Disease, Graves', EXOPHTHALMIC GOITER, EXOPHTHALMIC GOITRE, GRAVES' DISEASE, HYPERTHYROIDISM <GRAVES DISEASE>, HYPERTHYROIDISM, AUTOIMMUNE, GRD, GRAVES DISEASE, BASEDOW DIS, BASEDOWS DIS, GRAVES DIS, Graves' disease (diagnosis), Grave's disease, Graves' disease (diffuse toxic goiter), Autoimmune hyperthyroidism, Disease Graves', Goiter exophthalmic, HYPERTHYROIDISM GRAVES DISEASE, Graves Disease, Basedow disease, Graves Disease [Disease/Finding], Disease;Basedows, basedows disease, hyperthyroidism graves disease, Disease;Graves, disease graves, basedow's disease, graves' disease, graves disease, basedow disease, diseases graves, Graves disease, Hyperthyroidism, Autoimmune, Goitre exophthalmic, Graves' Disease - hyperthyroidism, Basedow's disease, Graves' disease, Graves' disease with exophthalmos, Toxic diffuse goiter with exophthalmos, Exophthalmic goiter, Exophthalmic goitre, Toxic diffuse goitre with exophthalmos, Graves' disease (disorder), Toxic diffuse goiter with exophthalmos (disorder), Basedow's disease (disorder), Flajani, Graves, Basedow, exophthalmic; goiter, exophthalmos; goiter (etiology), exophthalmos; goiter (manifestation), goiter; exophthalmos (etiology), goiter; exophthalmos (manifestation), struma; exophthalmic, Graves' disease [Ambiguous], exophthalmic goiter, Graves' Disease, Disease, Graves, Basedows disease, Graves-Basedow disease
French GOITRE EXOPHTALMIQUE, MALADIE DE GRAVES-BASEDOW, Hyperthyroïdie autoimmune, Hyperthyroïdie auto-immune, Goitre exophtalmique, Maladie de Basedow, Goitre toxique diffus, Maladie de Graves-Basedow, Maladie de Graves
Spanish ENFERMEDAD DE GRAVES, BOCIO EXOFTALMICO, Bocio exoftálmico, Enfermedad de Graves-Basedow, Hipertiroidismo autoinmune, bocio exoftálmico, enfermedad de Graves, Enfermedad de Graves (trastorno), enfermedad de Graves (trastorno), bocio difuso tóxico con exoftalmía, enfermedad de Graves con exoftalmos (trastorno), Enfermedad de Graves, bocio difuso tóxico con exoftalmía (trastorno), enfermedad de Graves con exoftalmos, bocio difuso tóxico con exoftalmos, enfermedad de Basedow (trastorno), enfermedad de Basedow, enfermedad de Graves (concepto no activo), Enfermedad de Basedow, Bocio Exoftálmico
Portuguese BOCIO EXOFTALMICO, Doença de Graves-Basedow, Bócio exoftálmico, DOENCA DE GRAVES-BASEDOW, Hipertiroidismo autoimune, Bócio Exoftalmico, Doença de Basedow, Doença de Graves
Dutch ziekte van Graves-Basedow, struma exoftalmisch, exoftalmische struma, exoftalmisch struma, ziekte van Graves, auto-immune hyperthyreoïdie, exoftalmie; struma, struma; exoftalmie, ziekte van Basedow, Basedow, ziekte van, Exoftalmisch struma, Struma, exoftalmisch, Ziekte van Graves
German Krankheit Basedow, Krankheit Graves, Graves-Basedow Krankheit, autoimmune Schilddruesenueberfunktion, BASEDOWSCHE KRANKHEIT, MORBUS BASEDOW, Basedow-Krankheit, Basedow-Struma, Exophthalmus mit Struma, Graves-Krankheit
Italian Malattia di Graves-Basedow, Malattia di Graves, Ipertiroidismo autoimmunitario, Gozzo esoftalmico, Morbo di Basedow, Morbo di Basedow-Graves, Malattia di Flajani-Basedow-Graves, Morbo di Graves
Japanese グレーブス・バセドウ病, ﾊﾞｾﾄﾞｳﾋﾞｮｳ, ｸﾞﾚｰﾌﾞｽﾋﾞｮｳ, ｸﾞﾚｰﾌﾞｽﾊﾞｾﾄﾞｳﾋﾞｮｳ, ｼﾞｺﾒﾝｴｷｾｲｺｳｼﾞｮｳｾﾝｷﾉｳｺｳｼﾝｼｮｳ, 自己免疫性甲状腺機能亢進症, ｶﾞﾝｷｭｳﾄｯｼｭﾂｾｲｺｳｼﾞｮｳｾﾝｼｭ, Graves氏病, グレーヴス病, グレーヴズ病, バセドウ病, 眼球突出性甲状腺腫, グレーブス病, 浸潤性眼障害, バーゼドー病, バセドー病, 眼障害-浸潤性, 甲状腺腫-眼球突出性, Basedow病, Graves病
Swedish Giftstruma
Czech Gravesova nemoc, Basedowova nemoc, Exoftalmická struma, Autoimunní hypertyroidismus, Basedowova choroba, Gravesova choroba, Graves-Basedowova choroba, Gravesova-Basedowova nemoc
Finnish Basedowin tauti
Russian BAZEDOVA BOLEZN', EKZOFTAL'MICHESKII ZOB, GREIVSA BOLEZN', ZOB EKZOFTAL'MICHESKII, ZOB DIFFUZNYI TOKSICHESKII, БАЗЕДОВА БОЛЕЗНЬ, ГРЕЙВСА БОЛЕЗНЬ, ЗОБ ДИФФУЗНЫЙ ТОКСИЧЕСКИЙ, ЗОБ ЭКЗОФТАЛЬМИЧЕСКИЙ, ЭКЗОФТАЛЬМИЧЕСКИЙ ЗОБ
Croatian GRAVESOVA BOLEST
Polish Choroba Gravesa-Basedowa, Wole nadczynne
Hungarian Graves-kór, Autoimmun hyperthyreosis, Graves betegség, Graves-Basedow-kór, Basedow-kór, Exophthalmikus struma
Norwegian Basedows sykdom, Graves’ sykdom, Toksisk struma, Toksisk diffust struma
Derived from the NIH UMLS (Unified Medical Language System)

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