Fact-sheet: Graves Basedow disease


Updated on 07/22/2024 at 10:10 AM

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Definition

Autoimmune hyperthyroidism related to the production of anti-TSH receptor antibodies (TRAb) stimulating T3 and T4 production.

Association with other autoimmune conditions (diabetes, adrenal insufficiency...)

Clinical features

Hyperthyroidism, thyrotoxicosis.

Diffuse, homogeneous, elastic goiter, with a bruit on auscultation.

Laboratory findings

Overt hyperthyroidism: low TSH, elevated free T4, elevated free T3

Positive anti-TSH receptor antibodies (60-80% of cases)

Anti-thyroid peroxidase and anti-thyroglobulin antibodies: may be found at low titers

Ultrasound

Reference examination: thyroid duplex ultrasound

  • Moderate goiter
  • Homogeneously hypoechoic
  • Hypervascularized ("thyroid inferno")
  • Doppler of the thyroid arteries: increased peak velocities > 100 cm/s (normal < 75 cm/s) and flow > 140 ml/min (though this measurement is imprecise). Useful for etiologic purposes relative to autoimmune thyroiditis, and for its predictive value of relapse after antithyroid drug withdrawal.

CT

For work-up of dysthyroid ophthalmopathy

MRI

Reference examination, non-irradiating, for the work-up of dysthyroid ophthalmopathy.

Nuclear medicine

Performed as second-line workup, thyroid scintigraphy shows diffuse, homogeneous tracer uptake.

Differential diagnosis

- Autoimmune thyroiditis (Doppler of thyroid arteries: peak systolic velocities 75-100 cm/s)