Graves disease

Dr Henry Knipe and Dr Yuranga Weerakkody et al.

Graves disease is an autoimmune thyroid disease and is the most common cause of thyrotoxicosis (up to 85%).

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:

Results from an antibody directed stimulation of the thyroid-stimulating hormone (TSH) receptor, with resultant production and release of T3 and T4.

The affected 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 receptor antibodies (TSI, TGI, TBII): positive
  • thyroid gland is often enlarged and can be hyperechoic
  • heterogeneous thyroid echotexture
  • relative absence of nodularity in uncomplicated cases
  • hypervascular; 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

For hyperthyroidism consider: 

It is named after Robert James Graves, Irish Surgeon (1796-1853).

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Article information

rID: 10695
System: Head & Neck
Section: Pathology
Synonyms or Alternate Spellings:
  • Graves' disease
  • Basedow disease

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Cases and figures

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    Thyroid follicle ...
    Figure 1: histology
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    Thyroid color dop...
    Case 1: with "thyroid inferno" appearance
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    Case 2: with thyroid orbitopathy
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    Visualization of ...
    Case 3: thyroid scintigraphy
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