Graves' disease: autoimmune hyperthyroidism

Stimulating anti-TSH receptor antibodies

Graves' disease is the leading cause of hyperthyroidism. Affects mainly women aged 20-40.

Symptoms

Weight loss with preserved appetite, palpitations, tremor, heat intolerance, sweating, anxiety, diffuse goiter, exophthalmos (50% of cases), pretibial myxedema (rare).

Diagnosis

Decreased TSH, elevated free T4/T3, anti-TSH receptor antibodies (TRAb). Thyroid ultrasound. Scintigraphy if doubt.

Three treatment options

• Antithyroid drugs (carbimazole, methimazole): 12-18 months, 40-50% remission
• Radioactive iodine: simple, effective, often leads to hypothyroidism
• Surgery (total thyroidectomy): large goiter, severe ophthalmopathy, pregnancy

Graves' ophthalmopathy

Tobacco worsens it dramatically. Teprotumumab: new effective biotherapy. Corticosteroids, orbital decompression in severe forms.