All about Graves disease

Graves’ disease is a thyroid disorder characterized by goiter, exophthalmos, “orange-peel” skin, and hyperthyroidism. It is caused by an antibody-mediated auto-immune reaction, but the trigger for this reaction is still unknown. It is the most common cause of hyperthyroidism in the world, and the most common cause of general thyroid enlargement in developed countries.

In some parts of Europe the term Basedow’s disease or Graves-Basedow disease is preferred to Graves’ disease.

Graves disease is known for its enlarged thyroid and eye problems. The ocular manifestations of Graves’ disease are more common in smokers and tend to worsen (or develop for the first time) following radioiodine treatment of the thyroid condition. Thus, they are not caused by hyperthyroidism per se. This common misperception may result from the fact that hyperthyroidism from other causes may cause eyelid retraction or eyelid lag (so-called hyperthyroid stare), which can be confused with the general appearance of proptosis or exophthalmos, despite the fact that the globes do not actually protrude in other causes of hyperthyroidism. Also, both conditions (globe protrusion and hyperthyroid lid retraction) may exist at the same time in the hyperthyroid patient with Graves’ disease.

Graves’ disease may present clinically with one of the following characteristic signs:

• exophthalmos (protuberance of one or both eyes)
• a non-pitting edema (pretibial myxedema) with thickening of the skin usually found on the lower extremities
• fatigue, weight loss with increased appetite, and other symptoms of hyperthyroidism
• rapid heart beats
• muscular weakness