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Graves' Disease

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Graves' Disease


The disease was first noted in 1786 by Caleb Hillier Parry 1755- 1822, physician from General Hospital, Bath, England. His account was published posthumously in 1825.
However Graves' disease is named after the Irish physician who described several cases in London Medical Journal in 1835. Graves' disease is also known as Parry's disease. In Europe, the disease is known as Basedow's disease. It is the most common cause of thyrotoxicosis (the morbid condition due to over activity of the thyroid gland).

The disorder has three major manifestations:
Hyperthyroidism with diffuse goiter
Ophthalmopathy
and Dermopathy

The three manifestations need not appear together. Indeed one or two never appear, and moreover, the three may run courses that are largely independent of one another.

Graves' disease can occur at any age but is unusual before puberty. It most commonly affects the 30 to 50 year age group. The disease is more frequent in women, the ratio of predominance in women may be as high as 7 : 1.
Genetic factors play a role. There is an association between the disease and the genes HLA ( human leucocyte antigen) B8, -DRw3, -Bw36, -Bw46. Indeed, a 50% concordance is found between identical twins. This means that if one individual in an identical pair of twins is afflicted with Graves' disease, the likelihood of the other sibling coming down with Graves' is 50%.

Being an autoimmune disease, there is a clinical and immunologic overlap between ...


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...in adulthood secondary to its usage. Radioiodine can ensure that mothers are not taking anti- thyroid drugs during pregnancy and breastfeeding. Therefore, an argument can be made for using this treatment method for all age groups except when pregnant or breastfeeding.

Relapse of Graves' disease after medical therapy may be managed with a second course, but at this point radioiodine is preferred. During pregnancy and breastfeeding periods, PTU ( propylthiouracil) appears to be the safest drug to use. And surgery is advised in cases with the presence of concomitant suspicious nodule.

Each of the 3 major treatments ( anti- thyroid drugs, surgery and radioactive iodine) has their own advantages and disadvantages compared to the others.

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