Graves' disease

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

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
Site thyroid gland

Associated Dx papillary thyroid carcinoma
Signs exophthalmos
Prevalence uncommon
Blood work TSH-receptor antibody - required

It is often misspelled "Grave's disease".

General

Clinical:

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

Gross

Features:[3]

  • Enlarged 50-150 g.
  • "Beefy-red" appearance, looks like raw beef.

Microscopic

Features:

  • Classic:
    • Hypercellular
    • Patchy lymphocytes.
    • 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:

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. Thompson, Lester D. R. (2006). Endocrine Pathology: A Volume in Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 30. ISBN 978-0443066856.
  4. URL: http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/enfrm.html. Accessed on: 4 December 2011.