ABSTRACT
Graves’ disease has three components: hyperthyroidism, ophthalmopathy, and dermopathy. Hyperthyroidism or thyrotoxicosis, the cardinal manifestation of Graves’ disease, occurs when body tissues are exposed to increased concentrations of tetraiodothyronine (T4) and/or triiodothyronine (T3). The causes of hyperthyroidism include Graves’ disease, thyroiditis, toxic multinodular goiter, toxic thyroid adenoma, exogenous hyperthyroidism (iatrogenic, factitious, iodine-induced), excess thyroid-stimulating hormone (TSH) (trophoblastic tumors, pituitary tumor), and ectopic thyroxine production (struma ovarii and metastatic follicular thyroid carcinoma). Graves’ disease is by far the most common cause of hyperthyroidism, with a female to male ratio of 7 or 8:1. It is typically a disease of young women (20-40 years), but Graves’ disease may occur in patients at any age. Graves’ disease is identified clinically from other forms of hyperthyroidism by the presence of diffuse thyroid enlargement, ophthalmopathy, and occasionally pretibial myxedema, although all these signs may be absent. Ophthalmopathy is present in 5-20% of patients with recent onset Graves’ disease and may occur before hyperthyroidism (‘‘euthyroid Graves’ disease’’), at the onset of hyperthyroidism (the usual case), or years later after the patient is euthyroid.
