GRAVES-DISEASE - CURRENT CONCEPTS

The cause of the hyperthyroidism of Graves' disease is an antibody (thyroid receptor antibody, TRAb) to the thyroid-stimulating hormone (TSH) receptor on follicular cells that can mimic the actions of TSH. The main symptoms and signs are due to excess thyroid hormones in the blood and excess action at the cellular level. There are extrathyroidal manifestations of Graves' disease, infiltrative ophthalmopathy, dermopathy, and acropachy that are not due to TRAb. Treatment of hyperthyroidism utilizes medications that interfere with the thyroid's ability to produce and secrete excess hormones, or surgery or radioiodine to reduce the volume of thyroid-producing hormones. It is not possible to correct selectively the immunologic abnormality. Medical therapy is effective, but there are drug side effects, including skin rashes, agranulocytosis, and hepatitis. Hypothyroidism and the need for lifelong levo-thyroxine is to be expected in almost all patients treated with radioiodine and, in the majority of patients, after thyroid surgery.