Autoimmune thyrotoxicosis: diagnostic challenges
Am J Med. 2012 Sep;125(9):S1
Ponto KA, Kahaly GJ
Abstract
Autoimmune thyrotoxicosis or Graves’ disease (GD) is the most common cause of hyperthyroidism in the United States (full text available online: http://education.amjmed.com/pp1/249).
GD occurs more often in women (ratio 5:1) and has a population prevalence of 1-2%.
A genetic determinant to the susceptibility to GD is suspected because of familial clustering of the disease, a high sibling recurrence risk, and the familial occurrence of thyroid autoantibodies.
GD is a systemic autoimmune thyroid disorder characterized by the infiltration of immune effector cells and thyroid-antigen-specific T cells into the thyroid and thyroid stimulating hormone receptor (TSHR) expressing tissues, i.e. orbit, skin, with the production of autoantibodies to well-defined thyroidal antigens.
Stimulatory autoantibodies in GD activate the TSHR leading to thyroid hyperplasia and unregulated thyroid hormone production and secretion.
Diagnosis of GD is straightforward in a patient with a diffusely enlarged, heterogeneous, hypervascular (increased Doppler flow on neck ultrasound) thyroid gland, associated orbitopathy, biochemically confirmed thyrotoxicosis, positive TSHR autoantibodies, and often a family history of autoimmune disorders.
PMID: 22938935
Graves Disease is an auto-immune illness. This means the immune system is having difficulty killing off every dangerous lymphocyte, letting some escape into the body.
Screening for the presence of other autoimmune illnesses and inappropriate antibodies to food is important to help determine other factors that cause the patient to become ill.
As the saying goes, if you have one auto-immune illness, you can have six or more.
It is possible to have Graves Disease and Hashimoto’s Thyroiditis at the same time. They are not mutually exclusive.
The presence of a inflammatory state in response to the bound antibodies contributes much to the behavioral changes associated with the autoimmune illness. In Graves Disease, the stimulated excessive thyroid signal also contributes to behavioral dysfunction.