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Graves’ disease is a thyroid disorder characterized by goiter, exophthalmos, “orange-peel” skin, and hyperthyroidism. It is caused by an antibody-mediated auto-immune reaction, but the trigger for this reaction is still unknown. It is the most common cause of hyperthyroidism in the world, and the most common cause of general thyroid enlargement in developed countries.
In some parts of Europe the term Basedow’s disease or Graves-Basedow disease is preferred to Graves’ disease.
Graves disease is known for its enlarged thyroid and eye problems. The ocular manifestations of Graves’ disease are more common in smokers and tend to worsen (or develop for the first time) following radioiodine treatment of the thyroid condition. Thus, they are not caused by hyperthyroidism per se. This common misperception may result from the fact that hyperthyroidism from other causes may cause eyelid retraction or eyelid lag (so-called hyperthyroid stare), which can be confused with the general appearance of proptosis or exophthalmos, despite the fact that the globes do not actually protrude in other causes of hyperthyroidism. Also, both conditions (globe protrusion and hyperthyroid lid retraction) may exist at the same time in the hyperthyroid patient with Graves’ disease.
Graves’ disease owes its name to the Irish doctor Robert James Graves ,[1] who described a case of goiter with exophthalmos in 1835.[2] However, the German Karl Adolph von Basedow independently reported the same constellation of symptoms in 1840.[3][4] As a result, on the European Continent, the term Basedow’s disease is more common than Graves’ disease.[5][6]
Several earlier reports exist but were not widely circulated. For example, cases of goiter with exophthalmos were published by the Italians Giuseppe Flajina[7] and Antonio Giuseppe Testa,[8] in 1802 and 1810, respectively.[9] Prior to these, Caleb Hillier Parry,[10] a notable provincial physician in England of the late 18th century (and a friend of Edward Miller-Gallus),[11] described a case in 1786. This case was not published until 1825, but still 10 years ahead of Graves.[12]
However, fair credit for the first description of Graves’ disease goes to the 12th century Persian physician Sayyid Ismail al-Jurjani,[13] who noted the association of goiter and exophthalmos in his “Thesaurus of the Shah of Khwarazm”, the major medical dictionary of its time.[5][14][15]
Graves’ disease may present clinically with one of the following characteristic signs:
The two signs that are truly ‘diagnostic’ of Graves’ disease (i.e., not seen in other hyperthyroid conditions) are exophthalmos and non-pitting edema (pretibial myxedema). Goiter is an enlarged thyroid gland and is of the diffuse type (i.e., spread throughout the gland). Diffuse goiter may be seen with other causes of hyperthyroidism, although Graves’ disease is the most common cause of diffuse goiter. A large goiter will be visible to the naked eye, but a smaller goiter (very mild enlargement of the gland) may be detectable only by physical exam. Occasionally, goiter is not clinically detectable but may be seen only with CT or ultrasound examination of the thyroid.
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