From the Guidelines
Graves' disease is not a catch-all term for all causes of hyperthyroidism but rather a specific autoimmune disorder that causes hyperthyroidism. While hyperthyroidism refers to any condition where the thyroid gland produces excessive thyroid hormones, Graves' disease is just one cause among several others, as noted in studies such as 1. In Graves' disease, the immune system produces antibodies called thyroid-stimulating immunoglobulins (TSIs) that attach to thyroid cells, causing them to overproduce thyroid hormones. This distinguishes it from other causes of hyperthyroidism such as toxic multinodular goiter, thyroiditis, excessive iodine intake, or thyroid adenomas.
Some key points to consider include:
- Common causes of hyperthyroidism include Graves disease, Hashimoto thyroiditis, and functional thyroid nodules, as mentioned in 1.
- Risk factors for a low TSH level include female sex; advancing age; black race; low iodine intake; personal or family history of thyroid disease; and ingestion of iodine-containing drugs, such as amiodarone, as noted in 1.
- The USPSTF found no direct evidence that treatment of thyroid dysfunction based on risk level alters final health outcomes, according to 1.
- Treatment options specifically for Graves' disease include antithyroid medications (methimazole or propylthiouracil), radioactive iodine therapy, or thyroid surgery, depending on factors such as age, pregnancy status, and severity of symptoms, as discussed in 1.
Graves' disease has specific characteristics including diffuse thyroid enlargement, ophthalmopathy (eye problems), and occasionally skin manifestations like pretibial myxedema. The most appropriate treatment for Graves' disease should be determined based on the individual patient's condition and medical history, considering the latest evidence from studies such as 1.
From the Research
Definition and Causes of Graves' Disease
- Graves' disease is an autoimmune disease that primarily affects the thyroid gland, causing hyperthyroidism 2.
- It is the most common cause of hyperthyroidism, especially in women of reproductive age 2.
- The disease is caused by autoantibodies to the thyroid-stimulating hormone receptor (TSHR) that act as agonists and induce excessive thyroid hormone secretion 2.
Hyperthyroidism and Graves' Disease
- Hyperthyroidism is an excessive concentration of thyroid hormones in tissues, which can be caused by increased synthesis of thyroid hormones, excessive release of preformed thyroid hormones, or an endogenous or exogenous extrathyroidal source 3.
- Graves' disease is one of the most common causes of hyperthyroidism, along with toxic multinodular goiter and toxic adenoma 3.
- Hyperthyroidism caused by Graves' disease can be treated with antithyroid medications, radioactive iodine ablation of the thyroid gland, or surgical thyroidectomy 3.
Treatment of Graves' Disease
- The treatment of Graves' disease has not changed substantially for many years and remains a choice between antithyroid drugs, radioiodine, or surgery 2.
- Antithyroid drugs, such as methimazole and propylthiouracil, are commonly used to treat Graves' hyperthyroidism 4, 5, 6.
- The choice of treatment depends on the underlying diagnosis, the presence of contraindications to a particular treatment modality, the severity of hyperthyroidism, and the patient's preference 3.