There is a strong female predilection with an F:M ratio of at least 5:1. It typically presents in middle age.
Patients are thyrotoxic. Extrathyroidal manifestations include:
- cutaneous manifestations of Graves disease
- thyroid dermopathy (formerly called pretibial myxedema): occurs in ~2% and almost always associated with thyroid ophthalmopathy
- skeletal manifestations of Graves disease
- thyroid acropachy: occurs in ~1%
- Graves ophthalmopathy (orbitopathy): affects 20-25% of cases
- encephalopathy associated with autoimmune thyroid disease (EAATD)
The combination of exophthalmos, palpitations, and goiter is called the Merseburger (or Merseburg) triad.
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
- TSH receptor antibodies (TSI, TGI, TBII): positive
- thyroid gland is often enlarged and hypoechogenic, can be hyperechoic
- heterogeneous thyroid echotexture
- relative absence of nodularity in uncomplicated cases
- hypervascular; may demonstrate a thyroid inferno pattern on color Doppler
- iodine-123: imaging performed at around 2-6 days; classically demonstrates homogeneously increased activity in an enlarged gland
- technetium-99m pertechnetate: homogeneously increased activity in an enlarged thyroid gland
History and etymology
It is named after Robert James Graves (1796-1852), Irish surgeon, who first described it in 1835 , and Carl Adolph von Basedow (1799-1854), German physician, who described it in 1840 . The Merseburger triad was first described by Basedow who practiced in Merseburg .
For hyperthyroidism consider:
- Marine-Lenhart syndrome
- toxic thyroid adenoma
- toxic multinodular goiter
- pituitary adenoma
- extrathyroid origin
- struma ovarii
- metastatic thyroid carcinoma
- factitious hyperthyroidism
- patients with Graves disease are at higher risk of iodinated contrast media-induced thyrotoxicosis