Graves’ disease /grāvz/ [Robert J. Graves, Irish physician, 1796–1853] , a multisystem autoimmune disorder characterized by pronounced hyperthyroidism, usually associated with an enlarged thyroid gland and exophthalmos (abnormal protrusion of the eyeball). The origin is unknown, but the disease is familial and is usually associated with thyroid-stimulating autoantibodies that bind to TSH receptors and stimulate thyroid secretion. The disease, which is five times more common in women than in men, occurs most frequently when the individual is between 30 and 60 years of age and can arise after an infection or physical or emotional stress. Typical signs, which are related to hyperthyroidism, are nervousness, a fine tremor of the hands, weight loss, fatigue, breathlessness, palpitations, increased heat intolerance, increased metabolic rate, and GI motility. An enlarged thymus, generalized hyperplasia of the lymph nodes, blurred or double vision, localized myxedema, atrial arrhythmias, and osteoporosis may occur. The diagnosis may be established by tests that measure TSH, thyroxine, and triiodothyronine levels in serum. If necessary, radioactive iodine uptake in the gland is tested. Treatment may include prescription of antithyroid drugs, such as methimazole, propylthiouracil, and iodine preparations. Radioactive iodine may be administered, but hospitalization for a few days is recommended for patients treated with a large dose. Occasionally subtotal thyroidectomy may be indicated. In patients with inadequately controlled disease, infection or stress may precipitate a life-threatening thyroid storm. The exophthalmia may or may not resolve with the treatment of the disease. Also called exophthalmic goiter, thyrotoxicosis, toxic goiter.
