Graves' Disease

Graves' Disease affects approximately three out of 1,000 people, and is more prevalent in women and in families with a history of the disorder. Discovered in 1835 by Robert Graves, affected patients are hyperthyroid (overactive thyroid hormone production). Graves' Disease is an autoimmune disorder in which an as yet unknown immunological defect results in production of autoantibodies to the TSH receptor (TRAb) located on the surface of thyroid cells. These antibodies bind the TSH receptor and stimulate it to overproduce thyroid hormones, resulting in the hyperthyroid state. This activation by TRAbs are not subject to the normal negative feedback loop.

Symptoms of Graves' disease include nervousness, irritability, unexplained weight loss, increased appetite, heat intolerance, excessive sweating, rapid pulse, thyroid enlargement, diarrhea, fine tremors in fingers and warm moist skin. About 50 percent of patients also develop ophthalmopathy, characterized by bulging eyes, often with red swollen lids. To a lesser degree, Graves' Disease patients may exhibit slightly bulging eyes and a staring appearance.

While the classical clinical signs of Graves' Disease are easily recognized by the practitioner, diagnostic tests can confirm both obvious and more subtle disease states. Graves' patients will exhibit low TSH values, as low as 1/100 the level of euthyroid patients. Consequently, thyroxine (T4) levels will be elevated, and a higher T3/T4 ratio is often observed. Additionally, there is a strong correlation between Graves' Disease and a positive TPOAb titer, the autoantibody against thyroid peroxidase. Recent studies demonstrate that greater than 70 percent of Graves' patients are TPOAb positive.

Treatment for Graves' Disease may include anti-thyroid drugs (Thionamides), thyroid ablation with I¹³¹ treatment or surgical thyroidectomy. When the need for thyroid removal or inactivation is necessary, the subsequent hypothyroidism will require thyroid hormone replacement therapy with L-Thyroxine (LT4).

For More Information

American Thyroid Association
Thyroid Foundation of Canada
National Graves' Disease Foundation
Gland Central
American Association of Clinical Chemistry (Clinical Chemistry Journal)
The Endocrine Society
CLIANet (Clinical Laboratory Improvement Amendments)
NCCLS (National Committee for Clinical Laboratory Standards)