Graves' disease

From Libre Pathology
Revision as of 04:23, 12 December 2015 by Michael (talk | contribs) (→‎General)
Jump to navigation Jump to search

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).

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:[5]

  • 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. 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. URL: http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/enfrm.html. Accessed on: 4 December 2011.