Graves Disease (Diffuse Hyperplasia)

Abstract

Graves disease, an autoimmune disorder, is the most common cause of hyperthyroidism. Graves disease is associated with antibodies against the thyrotropin receptor that stimulate the receptor and promote synthesis and secretion of thyroglobulin and follicular cell proliferation. Patients present with goiter and symptoms of hyperthyroidism, including anxiety, tachycardia, palpitations, tremor, heat sensitivity, and weight loss, and may develop ophthalmopathy and dermopathy. Patients may be treated symptomatically with β-blockers and with antithyroid medications (propothiouracil and methimazole), radioactive iodine, and surgery. Complications of untreated Graves disease are thyroid storm, muscle catabolism with myopathy, and bone catabolism with osteoporosis, among others. Graves disease occurs in 1 in 2,000 people in the United States. A study from Olmstead County, Minnesota, reports an incidence of 30 cases per 100,000 person years. Graves disease is more common in women than in men. There is a marked increase risk of Graves disease in the postpartum period. In men, Graves disease occurs at an older age and frequently is more severe and associated with greater ophthalmopathy. Graves disease occasionally occurs in children and has a high concordance in identical twins. Smoking is associated with an increased risk of Graves disease and Graves ophthalmopathy. Patients have elevated serum thyroxine and low thyroid-stimulating hormone levels. There is an association with HLA-B8 and DR3, and patients may have a familial predisposition to autoimmune disease, including thyroid disease. Thyroid carcinomas occasionally occur in thyroids involved by Graves disease. In a retrospective review of 61 thyroid carcinomas with concurrent Graves disease, 58 papillary carcinomas, 1 follicular carcinoma, 1 Hurthle cell carcinoma, and 1 medullary carcinoma were identified. Most (80 %) of the tumors were 1 cm or smaller. Incidental thyroid carcinomas are less prevalent in Graves disease than in multinodular goiter.