Multimedia
![]() | Media file 1: Pathophysiologic mechanisms of Graves disease relating thyroid-stimulating immunoglobulins to hyperthyroidism and ophthalmopathy. T4 is levothyroxine. T3 is triiodothyronine. |
![]() | Media file 2: Graves disease. Varying degrees of manifestations of Graves ophthalmopathy. |
More on Graves Disease |
| Overview: Graves Disease |
| Differential Diagnoses & Workup: Graves Disease |
| Treatment & Medication: Graves Disease |
| Follow-up: Graves Disease |
Multimedia: Graves Disease |
| References |
| « Previous Page |
References
Ellis H. Robert Graves: 1796-1852. Br J Hosp Med (Lond). Jun 2006;67(6):313. [Medline].
Cruz AA, Akaishi PM, Vargas MA, de Paula SA. Association between thyroid autoimmune dysfunction and non-thyroid autoimmune diseases. Ophthal Plast Reconstr Surg. Mar-Apr 2007;23(2):104-8. [Medline].
Jacobson EM, Tomer Y. The CD40, CTLA-4, thyroglobulin, TSH receptor, and PTPN22 gene quintet and its contribution to thyroid autoimmunity: back to the future. J Autoimmun. Mar-May 2007;28(2-3):85-98. [Medline].
Furszyfer J, Kurland LT, McConahey WM, Elveback LR. Graves' disease in Olmsted County, Minnesota, 1935 through 1967. Mayo Clin Proc. Sep 1970;45(9):636-44. [Medline].
Tunbridge WM, Evered DC, Hall R, et al. The spectrum of thyroid disease in a community: the Whickham survey. Clin Endocrinol (Oxf). Dec 1977;7(6):481-93. [Medline].
Vanderpump MP, Tunbridge WM, French JM, et al. The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham Survey. Clin Endocrinol (Oxf). Jul 1995;43(1):55-68. [Medline].
Nayak B, Burman K. Thyrotoxicosis and thyroid storm. Endocrinol Metab Clin North Am. Dec 2006;35(4):663-86, vii. [Medline].
Burch HB, Wartofsky L. Life-threatening thyrotoxicosis. Thyroid storm. Endocrinol Metab Clin North Am. Jun 1993;22(2):263-77. [Medline].
Park SE, Cho MA, Kim SH, Rhee Y, Kang ES, Ahn CW. The adaptation and relationship of FGF-23 to changes in mineral metabolism in Graves' disease. Clin Endocrinol (Oxf). Jun 2007;66(6):854-8. [Medline].
Bunevicius R, Prange AJ Jr. Psychiatric manifestations of Graves' hyperthyroidism: pathophysiology and treatment options. CNS Drugs. 2006;20(11):897-909. [Medline].
Vogel A, Elberling TV, Hørding M, Dock J, Rasmussen AK, Feldt-Rasmussen U. Affective symptoms and cognitive functions in the acute phase of Graves' thyrotoxicosis. Psychoneuroendocrinology. Jan 2007;32(1):36-43. [Medline].
Schwartz KM, Fatourechi V, Ahmed DD, Pond GR. Dermopathy of Graves' disease (pretibial myxedema): long-term outcome. J Clin Endocrinol Metab. Feb 2002;87(2):438-46. [Medline].
Chen JL, Chiu HW, Tseng YJ, Chu WC. Hyperthyroidism is characterized by both increased sympathetic and decreased vagal modulation of heart rate: evidence from spectral analysis of heart rate variability. Clin Endocrinol (Oxf). Jun 2006;64(6):611-6. [Medline].
Kung AW. Clinical review: Thyrotoxic periodic paralysis: a diagnostic challenge. J Clin Endocrinol Metab. Jul 2006;91(7):2490-5. [Medline].
Zaletel K, Krhin B, Gaberscek S, Pirnat E, Hojker S. The influence of the exon 1 polymorphism of the cytotoxic T lymphocyte antigen 4 gene on thyroid antibody production in patients with newly diagnosed Graves' disease. Thyroid. May 2002;12(5):373-6. [Medline].
Zaletel K, Krhin B, Gaberscek S, Hojker S. Thyroid autoantibody production is influenced by exon 1 and promoter CTLA-4 polymorphisms in patients with Hashimoto's thyroiditis. Int J Immunogenet. Apr 2006;33(2):87-91. [Medline].
Wang PW, Chen IY, Liu RT, Hsieh CJ, Hsi E, Juo SH. Cytotoxic T lymphocyte-associated molecule-4 gene polymorphism and hyperthyroid Graves' disease relapse after antithyroid drug withdrawal: a follow-up study. J Clin Endocrinol Metab. Jul 2007;92(7):2513-8. [Medline].
Ban Y, Tozaki T, Taniyama M, Tomita M, Ban Y. Association of a C/T single-nucleotide polymorphism in the 5' untranslated region of the CD40 gene with Graves' disease in Japanese. Thyroid. May 2006;16(5):443-6. [Medline].
Heward JM, Brand OJ, Barrett JC, Carr-Smith JD, Franklyn JA, Gough SC. Association of PTPN22 haplotypes with Graves' disease. J Clin Endocrinol Metab. Feb 2007;92(2):685-90. [Medline].
Benvenga S, Guarneri F, Vaccaro M, et al. Homologies between proteins of Borrelia burgdorferi and thyroid autoantigens. Thyroid. 2004;14:964-6. [Medline].
Gangi E, Kapatral V, El-Azami El-Idrissi M, et al. Characterization of a recombinant Yersinia enterocolitica lipoprotein; implications for its role in autoimmune response against thyrotropin receptor. Autoimmunity. Sep-Nov 2004;37(6-7):515-20. [Medline].
Cappelli C, Pirola I, De Martino E, Agosti B, Delbarba A, Castellano M. The role of imaging in Graves' disease: A cost-effectiveness analysis. Eur J Radiol. Apr 23 2007;[Medline].
Markovic V, Eterovic D. Thyroid echogenicity predicts outcome of radioiodine therapy in patients with graves' disease. J Clin Endocrinol Metab. Sep 2007;92(9):3547-52. [Medline].
Kubota S, Ohye H, Yano G, Nishihara E, Kudo T, Ito M. Two-day thionamide withdrawal prior to radioiodine uptake sufficiently increases uptake and does not exacerbate hyperthyroidism compared to 7-day withdrawal in Graves' disease. Endocr J. Oct 2006;53(5):603-7. [Medline].
Bonnema SJ, Bennedbaek FN, Veje A, et al. Propylthiouracil before 131I therapy of hyperthyroid diseases: effect on cure rate evaluated by a randomized clinical trial. J Clin Endocrinol Metab. 2004;89:4439-44. [Medline].
Read CH Jr, Tansey MJ, Menda Y. A 36-year retrospective analysis of the efficacy and safety of radioactive iodine in treating young Graves' patients. J Clin Endocrinol Metab. Sep 2004;89(9):4229-33. [Medline].
Ceccarelli C, Canale D, Battisti P, Caglieresi C, Moschini C, Fiore E. Testicular function after 131I therapy for hyperthyroidism. Clin Endocrinol (Oxf). Oct 2006;65(4):446-52. [Medline].
Rivkees SA, Dinauer C. An optimal treatment for pediatric Graves' disease is radioiodine. J Clin Endocrinol Metab. Mar 2007;92(3):797-800. [Medline].
Macchia PE, Bagattini M, Lupoli G, et al. High-dose intravenous corticosteroid therapy for Graves' ophthalmopathy. J Endocrinol Invest. 2001;24:152-8. [Medline].
Dickinson AJ, Vaidya B, Miller M, Coulthard A, Perros P, Baister E. Double-blind, placebo-controlled trial of octreotide long-acting repeatable (LAR) in thyroid-associated ophthalmopathy. J Clin Endocrinol Metab. Dec 2004;89(12):5910-5. [Medline].
Wemeau JL, Caron P, Beckers A, et al. Octreotide (long-acting release formulation) treatment in patients with graves' orbitopathy: clinical results of a four-month, randomized, placebo-controlled, double-blind study. J Clin Endocrinol Metab. 2005;90:841-8. [Medline].
Stan MN, Garrity JA, Bradley EA, Woog JJ, Bahn MM, Brennan MD. Randomized, double-blind, placebo-controlled trial of long-acting release octreotide for treatment of Graves' ophthalmopathy. J Clin Endocrinol Metab. Dec 2006;91(12):4817-24. [Medline].
Durrani OM, Reuser TQ, Murray PI. Infliximab: a novel treatment for sight-threatening thyroid associated ophthalmopathy. Orbit. Jun 2005;24(2):117-9. [Medline].
Salvi M, Vannucchi G, Campi I, Currò N, Dazzi D, Simonetta S. Treatment of Graves' disease and associated ophthalmopathy with the anti-CD20 monoclonal antibody rituximab: an open study. Eur J Endocrinol. Jan 2007;156(1):33-40. [Medline].
Grodski S, Stalberg P, Robinson BG, Delbridge LW. Surgery versus Radioiodine Therapy as Definitive Management for Graves' Disease: The Role of Patient Preference. Thyroid. Feb 2007;17(2):157-60. [Medline].
Pradeep PV, Agarwal A, Baxi M, Agarwal G, Gupta SK, Mishra SK. Safety and efficacy of surgical management of hyperthyroidism: 15-year experience from a tertiary care center in a developing country. World J Surg. Feb 2007;31(2):306-12; discussion 313. [Medline].
Panzer C, Beazley R, Braverman L. Rapid preoperative preparation for severe hyperthyroid Graves' disease. J Clin Endocrinol Metab. May 2004;89(5):2142-4. [Medline].
Erbil Y, Ozluk Y, Giris M, Salmaslioglu A, Issever H, Barbaros U. Effect of lugol solution on thyroid gland blood flow and microvessel density in the patients with Graves' disease. J Clin Endocrinol Metab. Jun 2007;92(6):2182-9. [Medline].
FDA MedWatch Safety Alerts for Human Medical Products. Propylthiouracil (PTU). US Food and Drug Administration. Available at http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm164162.htm. Accessed June 3, 2009.
Aktaran S, Akarsu E, Erbagci I, Araz M, Okumus S, Kartal M. Comparison of intravenous methylprednisolone therapy vs. oral methylprednisolone therapy in patients with Graves' ophthalmopathy. Int J Clin Pract. Jan 2007;61(1):45-51. [Medline].
Bartalena L, Marcocci C, Bogazzi F, et al. Relation between therapy for hyperthyroidism and the course of Graves' ophthalmopathy. N Engl J Med. Jan 8 1998;338(2):73-8. [Medline].
Bartalena L, Marcocci C, Bogazzi F, et al. Use of corticosteroids to prevent progression of Graves'' ophthalmopathy after radioiodine therapy for hyperthyroidism. N Engl J Med. Nov 16 1989;321(20):1349-52. [Medline].
Bartalena L, Tanda M L, Piantanida E, et al. Relationship between management of hyperthyroidism and course of the ophthalmopathy. J Endocrinol Invest. 2004;27:288-94. [Medline].
Brusco F, Gonzalez G, Soto N, Arteaga E. Successful treatment of hyperthyroidism with amiodarone in a patient with propylthiouracil-induced acute hepatic failure. Thyroid. 2004;14:862-5. [Medline].
Bunevicius R, Velickiene D, Prange AJ, Jr. Mood and anxiety disorders in women with treated hyperthyroidism and ophthalmopathy caused by Graves' disease. Gen Hosp Psychiatry. 2005;27:133-9. [Medline].
Chattaway JM, Klepser TB. Propylthiouracil versus methimazole in treatment of Graves' disease during pregnancy. Ann Pharmacother. Jun 2007;41(6):1018-22. [Medline].
De Bellis A, Sansone D, Coronella C, et al. Serum antibodies to collagen XIII: a further good marker of active Graves' ophthalmopathy. Clin Endocrinol (Oxf). 2005;62:24-9. [Medline].
Dickinson A J, Vaidya B, Miller M, et al. Double-blind, placebo-controlled trial of octreotide long-acting repeatable (LAR) in thyroid-associated ophthalmopathy. J Clin Endocrinol Metab. 2005;89:5910-5. [Medline].
Ebner R, Devoto MH, Weil D, Bordaberry M, Mir C, Martinez H. Treatment of thyroid associated ophthalmopathy with periocular injections of triamcinolone. Br J Ophthalmol. Nov 2004;88(11):1380-6. [Medline].
Finamor F E, Martins J R, Nakanami D, et al. Pentoxifylline (PTX)--an alternative treatment in Graves' ophthalmopathy (inactive phase): assessment by a disease specific quality of life questionnaire and by exophthalmometry in a prospective randomized trial. Eur J Ophthalmol. 2004;14:277-83. [Medline].
Franklyn JA. The management of hyperthyroidism [published erratum appears in N Engl J Med 1994 Aug 25;331(8):559]. N Engl J Med. Jun 16 1994;330(24):1731-8. [Medline].
Gungor K, Gonen S, Kisakol G, Dikbas O, Kaya A. ANCA positive propylthiouracil induced pyoderma gangrenosum. J Endocrinol Invest. Jun 2006;29(6):575-6. [Medline].
Hiraiwa T, Ito M, Imagawa A, et al. High diagnostic value of a radioiodine uptake test with and without iodine restriction in Graves' disease and silent thyroiditis. thyroid. 2004;14:531-5. [Medline].
Iwama S, Ikezaki A, Kikuoka N, et al. Association of HLA-DR, -DQ Genotype and CTLA-4 Gene Polymorphism with Graves' Disease in Japanese Children. Horm Res. 2005;63:55-60. [Medline].
Karincaoglu Y, Esrefoglu M, Aki T, Mizrak B. Propylthiouracil-induced vasculitic oral ulcers with anti-neutrophil cytoplasmic antibody. J Eur Acad Dermatol Venereol. Jan 2006;20(1):120-2. [Medline].
Klein I, Becker DV, Levey GS. Treatment of hyperthyroid disease. Ann Intern Med. Aug 15 1994;121(4):281-8. [Medline].
Marcocci C, Bartalena L, Tanda ML, et al. Comparison of the effectiveness and tolerability of intravenous or oral glucocorticoids associated with orbital radiotherapy in the management of severe Graves' ophthalmopathy: results of a prospective, single-blind, randomized study. J Clin Endocrinol Metab. 2001;86:3562-7. [Medline].
Metso S, Jaatinen P, Huhtala H, et al. Long-term follow-up study of radioiodine treatment of hyperthyroidism. Clin Endocrinol (Oxf). Nov 2004;61(5):641-8. [Medline].
Prummel MF, Terwee CB, Gerding MN, et al. A randomized controlled trial of orbital radiotherapy versus sham irradiation in patients with mild Graves' ophthalmopathy. J Clin Endocrinol Metab. 2004;89:15-20. [Medline].
Riis AL, Jørgensen JO, Gjedde S, et al. Whole body and forearm substrate metabolism in hyperthyroidism: evidence of increased basal muscle protein breakdown. Am J Physiol Endocrinol Metab. 2005/06;288(6):E1067-E1073.
Wakelkamp IM, Tan H, Saeed P, et al. Orbital irradiation for Graves' ophthalmopathy: Is it safe? A long-term follow-up study. Ophthalmology. 2004;111:1557-62. [Medline].
Williams DE, Chopra IJ, Orgiazzi J, Solomon DH. Acute effects of corticosteroids on thyroid activity in Graves' disease. J Clin Endocrinol Metab. Aug 1975;41(2):354-61. [Medline].
Yeung SC, Go R, Balasubramanyam A. Rectal administration of iodide and propylthiouracil in the treatment of thyroid storm. Thyroid. Oct 1995;5(5):403-5. [Medline].
Further Reading
Keywords
Graves’ disease, diffuse toxic goiter, thyrotoxicosis, hyperthyroidism, Basedow's disease, Basedow disease, autoimmune thyroid disorder, autoimmune polyglandular syndrome, pernicious anemia, vitiligo, diabetes mellitus type 1, autoimmune adrenal insufficiency, systemic lupus erythematosus, thyroid antigens, thyroglobulin, thyroperoxidase, sodium-iodide symporter, TSH receptor, life-threatening thyrotoxic crisis, thyroid storm, Graves ophthalmopathy, thyroid acropachy, severe weight loss
osteoporosis, apathetic hyperthyroidism, cardiac hypertrophy, CTLA-4, pretibial myxedema, palpitation, nervousness, tremor, heat intolerance, hyperdefecation, inability to concentrate, proximal muscle weakness, easy fatigability with physical activity, proptosis, lid retraction, lacrimation, gritty sensation in the eye, photophobia, eye pain, diplopia, hyperhidrosis, increased sweating
restlessness, anxiety, irritability, insomnia, thyrotoxic periodic paralysis, onycholysis, alopecia, hyperactive deep-tendon reflexes, brisk deep-tendon reflexes, hypokalemic periodic paralysis, atrial fibrillation, cardiomyopathy, elevated transaminases, lid lag, irregular menstrual periods, gynecomastia, impotence, increased sex hormone–binding globulin levels,decreased free testosterone levels, decreased parathyroid hormone levels, decreased total cholesterol, decreased triglycerides, hand tremor, thyroid bruits
conjunctival injection, conjunctival chemosis, Yersinia enterocolitica, postpartum thyroid syndrome, use of interferons, use of interleukins, injection of percutaneous ethanol




Multimedia: Graves Disease