Diffuse Toxic Goiter (Grave's Disease)

Diffuse Toxic Goiter (Grave's Disease)

Dr. Kennedy
Graves disease, the most common cause of hyperthyroidism (overactivity of the thyroid gland), with generalized diffuse overactivity (“toxicity”) of the entire thyroid gland which becomes enlarged into a goiter. There are three clinical components to Grave’s disease:

  • Hyperthyroidism(the
    presence of too much thyroid hormone)

  • Ophthalmopathy specifically involving exophthalmos (protrusion of the eyeballs),
  • Dermopathy with skin lesions.

The ophthalmopathy can cause sensitivity to light and a feeling of “sand in the eyes.” With further protrusion of the eyes, double vision and vision loss may occur. The ophthalmopathy tends to worsen with smoking. The dermopathy of Graves disease is a rare, painless, reddish
lumpy skin rash that of Graves disease is an autoimmune process. It is caused
by thyroid-stimulating antibodies which bind to and activate the thyrotropin
receptor on thyroid cells. Graves disease can run in families. The rate of concordance
for Graves disease is about 20% among monozygotic (identical) twins, and the
rate is much lower among dizygotic (nonidentical) twins, indicating that genes
make only a moderate contribution to the susceptibility to Graves disease. No
single gene is known to cause the disease or to be necessary for its development.
Factors that can trigger the onset of Graves disease include stress, smoking,
radiation to the neck, medications (such as interleukin-2 and interferon-alpha),
and infectious organisms such as viruses. The diagnosis of Graves disease is
made by a characteristic thyroid scan (showing diffusely increase uptake), the
characteristic triad of ophthalmopathy, dermopathy, and hyperthyroidism, or
blood testing for TSI (thyroid stimulating immunoglobulin) the level
of which is abnormally high. Current treatments for the hyperthyroidism of Graves
disease consist of antithyroid drugs, radioactive iodine, and surgery. There
is regional variation in which of these measures tends to be used — for example,
radioactive iodine is favored in North America and antithyroid drugs nearly
everywhere else. The surgery, subtotal thyroidectomy, is designed to remove
the majority of the overactive thyroid gland. The disease is named for Robert
Graves who in 1835 first identified the association of goiter, palpitations,
and exophthalmos.

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