Graves' disease

Nat Rev Dis Primers. 2020 Jul 2;6(1):52. doi: 10.1038/s41572-020-0184-y.

Abstract

Graves' disease (GD) is an autoimmune disease that primarily affects the thyroid gland. It is the most common cause of hyperthyroidism and occurs at all ages but especially in women of reproductive age. Graves' hyperthyroidism is caused by autoantibodies to the thyroid-stimulating hormone receptor (TSHR) that act as agonists and induce excessive thyroid hormone secretion, releasing the thyroid gland from pituitary control. TSHR autoantibodies also underlie Graves' orbitopathy (GO) and pretibial myxoedema. Additionally, the pathophysiology of GO (and likely pretibial myxoedema) involves the synergism of insulin-like growth factor 1 receptor (IGF1R) with TSHR autoantibodies, causing retro-orbital tissue expansion and inflammation. Although the aetiology of GD remains unknown, evidence indicates a strong genetic component combined with random potential environmental insults in an immunologically susceptible individual. The treatment of GD has not changed substantially for many years and remains a choice between antithyroid drugs, radioiodine or surgery. However, antithyroid drug use can cause drug-induced embryopathy in pregnancy, radioiodine therapy can exacerbate GO and surgery can result in hypoparathyroidism or laryngeal nerve damage. Therefore, future studies should focus on improved drug management, and a number of important advances are on the horizon.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Review

MeSH terms

  • Anti-Retroviral Agents / adverse effects*
  • Anti-Retroviral Agents / pharmacology
  • Disease Management
  • HIV Infections / complications*
  • HIV Infections / drug therapy
  • HIV Infections / physiopathology
  • Humans
  • Quality of Life / psychology
  • nef Gene Products, Human Immunodeficiency Virus
  • tat Gene Products, Human Immunodeficiency Virus
  • vpr Gene Products, Human Immunodeficiency Virus

Substances

  • Anti-Retroviral Agents
  • nef Gene Products, Human Immunodeficiency Virus
  • tat Gene Products, Human Immunodeficiency Virus
  • vpr Gene Products, Human Immunodeficiency Virus