[Frontiers In Bioscience, Landmark, 24, 35-47, Jan 1, 2019]

Graves’ disease in clinical perspective

Margret Ehlers1, Matthias Schott1, Stephanie Allelein1

1Division for Specific Endocrinology, Medical Faculty, University of Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany


1. Abstract
2. Introduction
3. Etiology and pathogenesis of Graves’ disease
3.1. Role of genetic factors
3.2. Role of environmental factors
4. Diagnosis of Graves’ disease
4.1. Clinical aspects and thyroid hormones
4.2. Detection of TSH receptor antibodies (TRAb)
5. Therapy
5.1. Antithyroid drug therapy
5.2. Ablative therapy
5.3. Follow-up
6. Graves’ ophthalmopathy
6.1. The Role of TSH receptor in Graves’ ophtalmopathy
7. Graves’ disease and pregnancy
8. References


Graves’ disease (GD) is the most common cause for hyperthyroidism in iodine-replete areas. The disease is caused by the appearance of stimulating TSH receptor autoantibodies (TRAb) leading to hyperthyroidism. Blocking and neutral TRAb have, however, also been described. TRAb can be measured either by competition assays, assays using a bridge technology or bioassays (for discriminating stimulating vs. blocking antibodies). Therapy of GD with antithyroid drugs belonging to the group of thionamides is the first-line treatment to be continued for 12 up to 18 months. In case of relapse, thyroid ablative therapy including radioiodine therapy or thyroidectomy, respectively, should be performed. Risk factors for relapse are a large thyroid volume, persistence of high TRAb serum titer, smoking, and others. Within this review, we will give insights into the pathogenesis of GD including the pathogenesis of Graves’ ophthalmopathy. We also describe recent developments of TRAb measurement, which is used for the diagnosis of GD as well as for outcome prediction. Finally, we discuss therapy aspects as well as the important issue of GD and pregnancy.


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Key Words: Thyroid, Graves’disease, Autoimmune Thyroiditis, TSH, Receptor, Autoantibodies, Relapse, Ophthalmopathy, Review

Send correspondence to: Margret Ehlers, Division for Specific Endocrinology, Medical Faculty, University of Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany, Tel: 492118104860, Fax: 492118117082, E-mail: margret.ehlers@med.uni-duesseldorf.de