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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*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}}
*Higher risk of [[papillary thyroid carcinoma]].
*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==
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*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 31: 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==

Latest revision as of 12:43, 21 April 2016

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

www:

Sign out

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.