Graves’ disease insights from a review of the Johns Hopkins surgical pathology archive

Excerpt

Graves’ disease (GD), a common autoimmune disease clinically characterized by goiter, hyperthyroidism, and orbitopathy (GO), is caused by antibodies directed against the TSH-receptor (TRAb). These antibodies are responsible for hyperthyroidism and contribute to GO and, possibly, pretibial myxedema and acropachy. GD is first treated with thionamide antithyroid drugs (ATD), but requires thyroid ablation with either radioiodine or thyroidectomy when relapse after one or two thionamide courses occurs or if long- term ATD treatment, a safe alternative treatment for GD [1], fails or is not feasible. Total thyroidectomy is preferred when the goiter is large and multinodular, when nodules suspicious for malignancy or hyperparathyroidism coexist, when avoiding exposure to radiation is critical (as for women who desire to become pregnant or have recently delivered), or when a rapid resolution of the hyperthyroidism is desired [2]. Patient’s choice is also essential. …