Graves' disease

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Graves' disease
Diagnosis in short

Graves' disease. H&E stain. (WC)
LM hypercellular appearance with patchy lymphocytes, little colloid that is scalloped, +/-nuclear clearing, +/-papillae
LM DDx papillary thyroid carcinoma
Gross "beefy-red" appearance, enlarged, +/-white nodules
Site thyroid gland
Associated Dx papillary thyroid carcinoma
Signs exophthalmos, signs of hyperthyroidism (tremor, muscle wasting, weight loss, tachycardia, sweating)
Symptoms symptoms of hyperthyroidism (palpitations, fatigue, restlessness, oligomenorrhea, amenorrhea, intolerance to heart, diarrhea, irritability)
Prevalence uncommon
Blood work TSH-receptor antibody - required

Graves' disease, also Graves disease, is an autoimmune disease that leads to hyperthyroidism.

It is often misspelled "Grave's disease".

General

Clinical:

  • TSH-receptor antibody +ve.[2]
  • +/-Exophthalmos (bulging eyes).

Hyperthyroidism

Mnemonic hyperTHYROIDISM:[3][4]

  • Tremor.
  • Heart rate elevated, palpitations.
  • Yawn (fatigue).
  • Restlessness.
  • Oligomenorrhea, amenorrhea.
  • Intolerance to heat.
  • Diarrhea.
  • Irritable.
  • Sweating.
  • Muscle wasting/weight loss.

Gross

Features:

  • Classic appearance:[5]
    • Enlarged 50-150 g.
    • "Beefy-red" appearance, looks like raw beef.
  • May have scattered white nodules (lymphocytes).

Microscopic

Features:

  • Classic:
    • Hypercellular
    • Patchy lymphocytes.[6]
    • Little colloid.
  • Scalloping of colloid; colloid has undulating border.
    • Non-specific finding.
  • +/-Nuclear clearing.
  • +/-Papillae (may mimic papillary thyroid carcinoma in this respect).

Notes:

  • Usually has an unimpressive appearance... as it is treated, i.e. history is important.
  • Nuclear clearing and papillae are usu. diffuse in Graves' disease - unlike in papillary thyroid carcinoma.

DDx:

Images

  • GD - low mag. (WC)

  • GD - intermed. mag. (WC)

  • GD - high mag. (WC)

  • GD - low mag. (WC)

  • GD - intermed. mag. (WC)

  • GD - high mag. (WC)

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History provided

Total Thyroid, Total Thyroidectomy:
- Lymphocytic thyroiditis compatible with Graves' disease. 
- One benign lymph node (0/1).
- NEGATIVE for malignancy.

See also

References

  1. ↑ Ergin, AB.; Saralaya, S.; Olansky, L.. "Incidental papillary thyroid carcinoma: clinical characteristics and prognostic factors among patients with Graves' disease and euthyroid goiter, Cleveland Clinic experience.". Am J Otolaryngol 35 (6): 784-90. doi:10.1016/j.amjoto.2014.04.013. PMID 25128909.
  2. ↑ Massart, C.; Gibassier, J.; d'Herbomez, M. (Sep 2009). "Clinical value of M22-based assays for TSH-receptor antibody (TRAb) in the follow-up of antithyroid drug treated Graves' disease: comparison with the second generation human TRAb assay.". Clin Chim Acta 407 (1-2): 62-6. doi:10.1016/j.cca.2009.06.033. PMID 19576193.
  3. ↑ Shiau, Carolyn; Toren, Andrew (2006). Toronto Notes 2006: Comprehensive Medical Reference (Review for MCCQE 1 and USMLE Step 2) (22nd edition (2006) ed.). Toronto Notes for Medical Students, Inc.. pp. E24. ISBN 978-0968592861.
  4. ↑ URL: http://www.prep4usmle.com/forum/thread/6731/2/. Accessed on: 1 May 2012.
  5. ↑ Thompson, Lester D. R. (2006). Endocrine Pathology: A Volume in Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 30. ISBN 978-0443066856.
  6. ↑ Leövey, A.; Bakó, G.; Sztojka, I.; Bordán, L.; Szabó, T.; Kálmán, K.; Balázs, C. (1982). "The pathogenetic connection between Graves' disease and chronic lymphocytic thyroiditis. (The role and incidence of thyroid stimulating antibodies).". Acta Med Acad Sci Hung 39 (1-2): 1-6. PMID 6129766.
  7. ↑ URL: http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/enfrm.html. Accessed on: 4 December 2011.
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