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Difference between revisions of "Graves' disease"
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{{ Infobox diagnosis | |||
| Name = {{PAGENAME}} | |||
| Image = Graves disease -- low mag.jpg | |||
| Width = | |||
| Caption = Graves' disease. [[H&E stain]]. (WC) | |||
| Synonyms = | |||
| Micro = hypercellular appearance with patchy lymphocytes, little colloid that is scalloped, +/-nuclear clearing, +/-papillae | |||
| Subtypes = | |||
| LMDDx = [[papillary thyroid carcinoma]] | |||
| Stains = | |||
| IHC = | |||
| EM = | |||
| Molecular = | |||
| IF = | |||
| Gross = "beefy-red" appearance, enlarged, +/-white nodules | |||
| Grossing = | |||
| Staging = | |||
| Site = [[thyroid gland]] | |||
| Assdx = [[papillary thyroid carcinoma]] | |||
| Syndromes = | |||
| Clinicalhx = | |||
| 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 | |||
| Bloodwork = TSH-receptor antibody - required | |||
| Rads = | |||
| Endoscopy = | |||
| Prognosis = | |||
| Other = | |||
| ClinDDx = | |||
| Tx = | |||
}} | |||
'''Graves' disease''', also '''Graves disease''', is an autoimmune disease that leads to hyperthyroidism. | '''Graves' disease''', also '''Graves disease''', is an autoimmune disease that leads to hyperthyroidism. | ||
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==General== | ==General== | ||
*[[Clinical diagnosis]]. | |||
*Autoimmune disease leading to hyperthyroidism. | *Autoimmune disease leading to hyperthyroidism. | ||
*Eye problems not resolved with thyroid removal.{{fact}} | *Eye problems not resolved with thyroid removal.{{fact}} | ||
* | *Increased risk of [[papillary thyroid carcinoma]] compared to general population.<ref>{{Cite journal | last1 = Ergin | first1 = AB. | last2 = Saralaya | first2 = S. | last3 = Olansky | first3 = L. | title = Incidental papillary thyroid carcinoma: clinical characteristics and prognostic factors among patients with Graves' disease and euthyroid goiter, Cleveland Clinic experience. | journal = Am J Otolaryngol | volume = 35 | issue = 6 | pages = 784-90 | month = | year = | doi = 10.1016/j.amjoto.2014.04.013 | PMID = 25128909 }}</ref> | ||
Clinical: | Clinical: | ||
*TSH-receptor antibody +ve.<ref name=pmid19576193>{{Cite journal | last1 = Massart | first1 = C. | last2 = Gibassier | first2 = J. | last3 = d'Herbomez | first3 = M. | title = 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. | journal = Clin Chim Acta | volume = 407 | issue = 1-2 | pages = 62-6 | month = Sep | year = 2009 | doi = 10.1016/j.cca.2009.06.033 | PMID = 19576193 }}</ref> | *TSH-receptor antibody +ve.<ref name=pmid19576193>{{Cite journal | last1 = Massart | first1 = C. | last2 = Gibassier | first2 = J. | last3 = d'Herbomez | first3 = M. | title = 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. | journal = Clin Chim Acta | volume = 407 | issue = 1-2 | pages = 62-6 | month = Sep | year = 2009 | doi = 10.1016/j.cca.2009.06.033 | PMID = 19576193 }}</ref> | ||
*+/-Exophthalmos (bulging eyes). | |||
===Hyperthyroidism=== | |||
Mnemonic ''hyperTHYROIDISM'':<ref name=Ref_TN2006_E24>{{Ref TN2006|E24}}</ref><ref>URL: [http://www.prep4usmle.com/forum/thread/6731/2/ http://www.prep4usmle.com/forum/thread/6731/2/]. Accessed on: 1 May 2012.</ref> | |||
*Tremor. | |||
*Heart rate elevated, palpitations. | |||
*Yawn (fatigue). | |||
*Restlessness. | |||
*Oligomenorrhea, amenorrhea. | |||
*Intolerance to heat. | |||
*Diarrhea. | |||
*Irritable. | |||
*Sweating. | |||
*Muscle wasting/weight loss. | |||
==Gross== | ==Gross== | ||
Features:<ref>{{Ref EP|30}}</ref> | Features: | ||
*Enlarged 50-150 g. | *Classic appearance:<ref name=Ref_EP30>{{Ref EP|30}}</ref> | ||
*"Beefy-red" appearance, looks like raw beef. | **Enlarged 50-150 g. | ||
**"Beefy-red" appearance, looks like raw beef. | |||
*May have scattered white nodules (lymphocytes). | |||
==Microscopic== | ==Microscopic== | ||
| Line 20: | Line 69: | ||
*Classic: | *Classic: | ||
**Hypercellular | **Hypercellular | ||
**Patchy lymphocytes. | **Patchy lymphocytes.<ref name=pmid6129766>{{Cite journal | last1 = Leövey | first1 = A. | last2 = Bakó | first2 = G. | last3 = Sztojka | first3 = I. | last4 = Bordán | first4 = L. | last5 = Szabó | first5 = T. | last6 = Kálmán | first6 = K. | last7 = Balázs | first7 = C. | title = The pathogenetic connection between Graves' disease and chronic lymphocytic thyroiditis. (The role and incidence of thyroid stimulating antibodies). | journal = Acta Med Acad Sci Hung | volume = 39 | issue = 1-2 | pages = 1-6 | month = | year = 1982 | doi = | PMID = 6129766 }}</ref> | ||
**Little colloid. | **Little colloid. | ||
*Scalloping of colloid; colloid has undulating border. | *Scalloping of colloid; colloid has undulating border. | ||
| Line 30: | Line 79: | ||
*Usually has an unimpressive appearance... as it is treated, i.e. history is important. | *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. | *Nuclear clearing and papillae are usu. diffuse in Graves' disease - unlike in papillary thyroid carcinoma. | ||
DDx: | |||
*[[Papillary thyroid carcinoma]]. | |||
*[[Lymphocytic thyroiditis]]. | |||
===Images=== | ===Images=== | ||
<gallery> | |||
Image: Graves disease -- low mag.jpg | GD - low mag. (WC) | |||
Image: Graves disease -- intermed mag.jpg | GD - intermed. mag. (WC) | |||
Image: Graves disease -- high mag.jpg | GD - high mag. (WC) | |||
Image: Graves disease - alt -- low mag.jpg | GD - low mag. (WC) | |||
Image: Graves disease - alt -- intermed mag.jpg | GD - intermed. mag. (WC) | |||
Image: Graves disease - alt -- high mag.jpg | GD - high mag. (WC) | |||
</gallery> | |||
www: | www: | ||
*[http://library.med.utah.edu/WebPath/jpeg4/ENDO022.jpg Graves' disease (med.utah.edu)].<ref>URL: [http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/enfrm.html http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/enfrm.html]. Accessed on: 4 December 2011.</ref> | *[http://library.med.utah.edu/WebPath/jpeg4/ENDO022.jpg Graves' disease (med.utah.edu)].<ref>URL: [http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/enfrm.html http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/enfrm.html]. Accessed on: 4 December 2011.</ref> | ||
*[http://medcell.med.yale.edu/histology/endocrine_systems_lab/graves_disease.php Graves' disease & normal thyroid (yale.edu)]. | *[http://medcell.med.yale.edu/histology/endocrine_systems_lab/graves_disease.php Graves' disease & normal thyroid (yale.edu)]. | ||
==Sign out== | |||
===History provided=== | |||
<pre> | |||
Total Thyroid, Total Thyroidectomy: | |||
- Lymphocytic thyroiditis compatible with Graves' disease. | |||
- One benign lymph node (0/1). | |||
- NEGATIVE for malignancy. | |||
</pre> | |||
==See also== | ==See also== | ||
*[[Thyroid gland]]. | *[[Thyroid gland]]. | ||
*[[Hashimoto's thyroiditis]]. | |||
==References== | ==References== | ||