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. 2011 Jun;2(3):135-44.
doi: 10.1177/2042018811408488.

Current concepts in graves' disease

Christian M Girgis  1 , Bernard L Champion, Jack R Wall
Affiliations

Current concepts in graves' disease

Christian M Girgis et al. Ther Adv Endocrinol Metab. 2011 Jun.

Abstract

Graves' disease is the most common cause of hyperthyroidism in the developed world. It is caused by an immune defect in genetically susceptible individuals in whom the production of unique antibodies results in thyroid hormone excess and glandular hyperplasia. When unrecognized, Graves' disease impacts negatively on quality of life and poses serious risks of psychosis, tachyarrhythmia and cardiac failure. Beyond the thyroid, Graves' disease has diverse soft-tissue effects that reflect its systemic autoimmune nature. Thyroid eye disease is the most common of these manifestations and is important to recognise given its risk to vision and potential to deteriorate in response to radioactive iodine ablation. In this review we discuss the investigation and management of Graves' disease, the recent controversy regarding the hepatotoxicity of propylthiouracil and the emergence of novel small-molecule thyroid-stimulating hormone (TSH) receptor ligands as potential targets in the treatment of Graves' disease.

Keywords: Graves' disease; autoimmune thyroid disease; hyperthyroidism; neomercazole; propylthiouracil; radioactive iodine; thionamides; thyroid eye disease; thyroidectomy.

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Conflict of interest statement

The authors have no disclosures, financial or otherwise, to report.

Figures

Figure 1.
Figure 1.
Images of extrathyroidal features of Graves' disease: characteristic features of thyroid eye disease including marked chemosis and eyelid oedema (A); eyelid retraction, swelling and exophthalmos (B). Also shown are features of thyroid acropachy in a patient with Graves' disease including soft-tissue oedema and clubbing (C) with the characteristic eroded bone margins of the phalanges suggestive of new periosteal bone formation and periosteitis (D).
Figure 2.
Figure 2.
Radionuclide thyroid scintigraphy.99mTC-pertechnetate thyroid scintigraphy demonstrating diffusely increased uptake in Graves' disease (A); a focal area of increased uptake due to an autonomously hyperfunctioning nodule (arrow, B); diffusely reduced uptake in a patient with thyroiditis (C).
Figure 3.
Figure 3.
Thyroid ultrasonography in a patient with Graves' disease. Characteristic ultrasonographic features of Graves' disease include diffuse enlargement of the thyroid with hypoechoic areas (A). The isthmus is 2 cm in width, approximately three times its normal thickness (B).
Figure 4.
Figure 4.
Treatment algorithm for Graves' disease.
See this image and copyright information in PMC

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