Graves disease goiter
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Graves' Disease and Goiter: A Comprehensive Overview
Introduction to Graves' Disease and Goiter
Graves' disease (GD) is an autoimmune disorder that primarily affects the thyroid gland, leading to hyperthyroidism and goiter. This condition is characterized by the presence of circulating autoantibodies that bind to and stimulate the thyroid hormone receptor (TSHR), causing the thyroid gland to produce excessive thyroid hormones1. The disease can also manifest in other organs, leading to conditions such as Graves' ophthalmopathy, dermopathy, and acropachy1.
Pathophysiology of Graves' Disease
Autoimmune Mechanisms
The primary mechanism behind GD involves the production of thyroid-stimulating immunoglobulins (TSI) that target the TSHR, leading to thyroid hyperfunction and hyperplasia6. This autoimmune response results in the characteristic symptoms of hyperthyroidism and goiter. The exact etiology of GD is complex and involves a combination of genetic susceptibility and environmental factors1.
Extrathyroidal Manifestations
Graves' disease can affect organs other than the thyroid, most notably the eyes, leading to Graves' ophthalmopathy, which occurs in approximately 50% of patients1. This condition is characterized by inflammation and tissue remodeling around the eyes, causing symptoms such as bulging eyes and vision problems3. Other rare manifestations include Graves' dermopathy and acropachy1.
Clinical Features and Diagnosis
Thyrotoxicosis and Goiter
Clinically, GD is marked by symptoms of thyrotoxicosis, such as weight loss, increased appetite, and nervousness, along with the presence of a diffuse goiter1. The diagnosis is typically confirmed by detecting serum anti-TSHR autoantibodies (TRAbs)1.
Functioning Nodules
In some cases, GD can present with functioning nodules, a condition known as Marine-Lenhart syndrome. This syndrome is characterized by the presence of both diffuse goiter and autonomous thyroid nodules, which can complicate the clinical picture and make differentiation from other thyroid disorders challenging2.
Treatment Strategies
Antithyroid Drugs
The first line of treatment for GD involves the use of antithyroid drugs (ATDs) such as methimazole or propylthiouracil, which help control hyperthyroidism by inhibiting thyroid hormone synthesis5. However, long-term remission is achieved in only about one-third of patients after ATD withdrawal8.
Radioactive Iodine and Surgery
For patients who relapse after ATD treatment, radioactive iodine therapy or thyroidectomy are common long-term treatment options. Total thyroidectomy is often preferred in cases of large or multinodular goiters, or when rapid resolution of hyperthyroidism is needed5. Surgical treatment is also considered for children with huge goiters who do not respond to ATD therapy9.
Goiter Dispersion Formula
Recent studies have explored the combined use of traditional Chinese medicine, such as the goiter dispersion formula, with ATDs. This combination has shown to improve treatment outcomes by modulating cytokine levels in patients with neurologic manifestations of GD4.
Special Considerations
Demographic Factors
Age and gender can influence the clinical features and outcomes of GD. Younger patients are more likely to present with larger goiters, but age and gender do not significantly predict the overall treatment outcome8.
Pregnancy and Fetal Goiter
Managing GD during pregnancy, especially in cases of triiodothyronine (T3)-predominant GD, requires careful monitoring and adjustment of antithyroid medication to prevent fetal complications such as fetal goiter7.
Conclusion
Graves' disease is a multifaceted autoimmune disorder with a primary impact on the thyroid gland, leading to hyperthyroidism and goiter. The disease can also present with extrathyroidal manifestations and functioning nodules, complicating the clinical picture. Treatment typically involves antithyroid drugs, with radioactive iodine therapy or surgery as long-term options for relapsing cases. Understanding the influence of demographic factors and special considerations such as pregnancy is crucial for effective management of GD.
Sources and full results
Most relevant research papers on this topic
Diagnosis and classification of Graves' disease.
Graves' disease is an autoimmune thyroid disorder characterized by hyperthyroidism, goiter, and extrathyroidal manifestations, with a complex interaction between genetic susceptibility and environmental factors.
Highly CitedGraves' disease with functioning nodules (Marine-Lenhart syndrome).
The syndrome of Graves' disease with functioning nodules (Marine-Lenhart syndrome) is a distinct subtype of Graves' disease, but its clinical differentiation from autonomous nodular goiter remains unclear.
Case ReportHighly CitedClassification of the eye changes of Graves' disease.
The classification of eye changes in Graves' disease, developed by a committee of the Presbyterian Hospital in New York and the American Thyroid Association, is a useful tool for describing and evaluating these changes in patients.
Highly CitedEffect of Goiter Dispersion Formula on Serum Cytokines in Hyperthyroidism Patients with Neurologic Manifestations of Graves' Disease: A Randomized Trial on 80 Cases.
Goiter dispersion formula significantly improves treatment outcomes of antithyroid drugs in hyperthyroidism patients with neurologic manifestations of Graves' disease by modulating IL-2, IL-8, and IL-17 levels.
RCTGraves’ disease insights from a review of the Johns Hopkins surgical pathology archive
Graves' disease (GD) is a common autoimmune disease characterized by goiter, hyperthyroidism, and orbitopathy, with potential links to differentiated thyroid cancer (DTC).
Rigorous JournalAssays for thyroid growth immunoglobulins and their clinical implications: methods, concepts, and misconceptions.
Thyroid growth immunoglobulins (TSI) play a crucial role in regulating thyroid cell proliferation, with their presence in plasma potentially affecting thyroid function and goiter size in Graves' disease.
Fetal goiter identified in a pregnant woman with triiodothyronine-predominant graves’ disease: a case report
Reducing antithyroid medication in a pregnant woman with T3-predominant Graves' disease can reduce fetal goiter and improve hydramnios, but further investigation is needed.
Case Report
Very Rigorous JournalInfluence of Demographic Factors on Clinical Features and Outcome of Graves‘ Disease
Age less than 40 years is a significant predictor for the presence of large goiter at diagnosis, but age and gender do not predict the outcome of Graves' disease.
Observational StudySurgical treatment of children Graves' disease with huge goiter-a case report and literature review.
Total thyroidectomy is a successful surgical treatment for children with Graves' disease and huge goiter, improving symptoms and reducing complications without requiring antithyroid drug therapy.
Case ReportInduction of Graves-like disease in mice by immunization with fibroblasts transfected with the thyrotropin receptor and a class II molecule.
Immunization with fibroblasts transfected with both the thyrotropin receptor and a class II molecule can induce Graves-like disease in mice, with major humoral and histological features of the autoimmune thyroid disease.
Non-RCT
Animal StudyHighly Cited