There a strong female predilection with the F:M ratio of at least 5:1. Typically presents in middle age.
Patients are thyrotoxic
Extra thyroid manifestations include
- cutaneous manifestations of Graves disease
- skeletal manifestations of Graves disease
- Graves ophthalmopathy or orbitopathy: affects ~ 20-25 % of cases
- Graves encephalopathy 2
Results from an antibody directed stimulation of the thyroid-stimulating hormone (TSH) receptor, with resultant production and release of T3 and T4.
The effected gland shows diffuse, symmetrical enlargement, with a fleshy red cut surface. This appearance can be altered by preoperative treatment or chronicity.
The histological features are consistent with the activated state of the gland:
- plump follicular cells with increased amounts of eosinophilic cytoplasm
- hyperplastic follicles with papillary epithelial infoldings
- evidence of colloid reabsorption including 'scalloping' at the apical membrane and variable follicle collapse and exhaustion
These features can be altered by preoperative treatment or chronicity.
- TSH - suppressed
- T4 - elevated
- T3 - elevated
- thyroid recepter antibodies (TSI, TGI, TBII) - positive
- the thyroid gland is often enlarged and can be hyperechoic
- the is a relative absence of nodularity in uncomplicated cases.
- hyper vascular and may demonstrate a "thyroid inferno" pattern on colour Doppler 1.
- I 123 - imaging performed at around 2-6 days. classically demonstrates homogeneously increased activity in an enlarged gland
- Tc 99 Pertechnetate - homogeneously increased activity in an enlarged thyroid gland
Differential diagnoses for hyperthyroidism
- Marine-Lenhart syndrome
- toxic adenoma
- toxic multinodular goiter
- subacute thyroiditis
- postpartum thyroiditis
- silent thyroiditis
- pituitary adenoma
- extrathyroid origin
- Struma ovarii
- metastatic thyroid carcinoma
- factitious hyperthyroidism
It is named after Robert James Graves: Irish Surgeon (1796 -1853)
- 1. Ralls PW, Mayekawa DS, Lee KP et-al. Color-flow Doppler sonography in Graves disease: "thyroid inferno". AJR Am J Roentgenol. 1988;150 (4): 781-4. AJR Am J Roentgenol (abstract) - Pubmed citation
- 2. Utku U, Asil T, Celik Y et-al. Reversible MR angiographic findings in a patient with autoimmune Graves disease. AJNR Am J Neuroradiol. 2004;25 (9): 1541-3. AJNR Am J Neuroradiol (full text) - Pubmed citation
- 3. Silverman PM, Newman GE, Korobkin M et-al. Computed tomography in the evaluation of thyroid disease. AJR Am J Roentgenol. 1984;142 (5): 897-902. AJR Am J Roentgenol (abstract) - Pubmed citation
- 4. Castagnone D, Rivolta R, Rescalli S et-al. Color Doppler sonography in Graves' disease: value in assessing activity of disease and predicting outcome. AJR Am J Roentgenol. 1996;166 (1): 203-7. AJR Am J Roentgenol (abstract) - Pubmed citation
- 5. S E M Clarke, FRCP and S C Rankin, FRCR ,The thyroid gland, Imaging 14:103-114 (2002)
- 6. Charkes ND, Maurer AH, Siegel JA et-al. MR imaging in thyroid disorders: correlation of signal intensity with Graves disease activity. Radiology. 1987;164 (2): 491-4. Radiology (abstract) - Pubmed citation
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