Graves’ disease is an autoimmune disorder that can cause hyperthyroidism, or an overactive thyroid. It results from an imbalance in the immune system, leading to the production of thyroid-stimulating antibodies [1]. It belongs to the group of autoimmune thyroid diseases (AITD), which also includes Hashimoto’s disease [2]. Graves’ disease is the most common cause of hyperthyroidism, accounting for approximately 80%-85% of all hyperthyroidism cases, and it affects about 3% of women and 0.5% of men during their lifetime [2].
The symptoms of Graves’ disease are primarily related to the thyroid gland’s excessive activity, including anxiety, nervousness, irritability, lack of concentration, insomnia, increased appetite with weight loss, and, in some cases, eye disorders like bulging eyes. Laboratory tests usually reveal elevated levels of FT3 and FT4 and decreased TSH levels.
Thyroid ultrasound examination typically shows diffuse thyroid enlargement without significant nodules.
The TSH receptor serves as the autoantigen in Graves’ disease, and the detection of TSH receptor autoantibodies (TRAb) can help distinguish Graves’ disease from other forms of hyperthyroidism.
TRAb consists of thyroid-stimulating antibodies (TSAb) and thyroid-blocking antibodies (TBA), and about 90% of Graves’ disease patients tested positive for TRAb using third-generation technology [5].
Some may wonder if it’s possible to diagnose without TRAb testing, relying solely on thyroid hormone indicators and the physician’s experience. An analysis of 316 hyperthyroid patients in the UK conducted by the University of Manchester Medical School [6] found that cases where TRAb testing was not performed during initial diagnosis had a false-negative rate of 12% and a false-positive rate of 34%. This means that more than one-third of non-Graves hyperthyroidism cases were incorrectly diagnosed as Graves’ disease. Checking TRAb may be a necessary step in diagnosing hyperthyroidism and Graves’ disease [7].
Summary
Graves’ Disease is not solely characterized by an overactive thyroid. It is, in fact, an autoimmune disease identified by the presence of positive autoantibodies known as TRAb.
For accurate diagnosis and disease monitoring, it is crucial to regularly test for TRAb. When TRAb levels become negative, it indicates that Graves’ Disease is in remission.
References:
[1] https://www.mayoclinic.org/diseases-conditions/graves-disease/symptoms-causes/syc-20356240
[2] Burch, H. B., & Cooper, D. S. (2015). Management of Graves Disease: A Review. JAMA, 314(23), 2544–2554. https://doi.org/10.1001/jama.2015.16535
[3] Ross, D. S., Burch, H. B., Cooper, D. S., Greenlee, M. C., Laurberg, P., Maia, A. L., Rivkees, S. A., Samuels, M., Sosa, J. A., Stan, M. N., & Walter, M. A. (2016). 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid : official journal of the American Thyroid Association, 26(10), 1343–1421. https://doi.org/10.1089/thy.2016.0229
[4] Laurberg, P., Wallin, G., Tallstedt, L., Abraham-Nordling, M., Lundell, G., & Tørring, O. (2008). TSH-receptor autoimmunity in Graves’ disease after therapy with anti-thyroid drugs, surgery, or radioiodine: a 5-year prospective randomized study. European journal of endocrinology, 158(1), 69–75. https://doi.org/10.1530/EJE-07-0450
[5] Barbesino, G., & Tomer, Y. (2013). Clinical review: Clinical utility of TSH receptor antibodies. The Journal of clinical endocrinology and metabolism, 98(6), 2247–2255. https://doi.org/10.1210/jc.2012-4309
[6] Bell, L., Hunter, A. L., Kyriacou, A., Mukherjee, A., & Syed, A. A. (2018). Clinical diagnosis of Graves’ or non-Graves’ hyperthyroidism compared to TSH receptor antibody test. Endocrine connections, 7(4), 504–510. https://doi.org/10.1530/EC-18-0082
[7] Wallaschofski, H., Kuwert, T., & Lohmann, T. (2004). TSH-receptor autoantibodies – differentiation of hyperthyroidism between Graves’ disease and toxic multinodular goitre. Experimental and clinical endocrinology & diabetes : official journal, German Society of Endocrinology [and] German Diabetes Association, 112(4), 171–174. https://doi.org/10.1055/s-2004-
