Difference between revisions of "Graves' disease"
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| Line 13: | Line 13: | ||
| Molecular = | | Molecular = | ||
| IF = | | IF = | ||
| Gross = "beefy-red" appearance, enlarged | | Gross = "beefy-red" appearance, enlarged, +/-white nodules | ||
| Grossing = | | Grossing = | ||
| Staging = | | Staging = | ||
| Line 20: | Line 20: | ||
| Syndromes = | | Syndromes = | ||
| Clinicalhx = | | Clinicalhx = | ||
| Signs = exophthalmos | | Signs = exophthalmos, signs of hyperthyroidism (tremor, muscle wasting, weight loss, tachycardia, sweating) | ||
| Symptoms = | | Symptoms = symptoms of hyperthyroidism (palpitations, fatigue, restlessness, oligomenorrhea, amenorrhea, intolerance to heart, diarrhea, irritability) | ||
| Prevalence = uncommon | | Prevalence = uncommon | ||
| Bloodwork = TSH-receptor antibody - required | | Bloodwork = TSH-receptor antibody - required | ||
| Line 44: | Line 44: | ||
*TSH-receptor antibody +ve.<ref name=pmid19576193>{{Cite journal | last1 = Massart | first1 = C. | last2 = Gibassier | first2 = J. | last3 = d'Herbomez | first3 = M. | title = Clinical value of M22-based assays for TSH-receptor antibody (TRAb) in the follow-up of antithyroid drug treated Graves' disease: comparison with the second generation human TRAb assay. | journal = Clin Chim Acta | volume = 407 | issue = 1-2 | pages = 62-6 | month = Sep | year = 2009 | doi = 10.1016/j.cca.2009.06.033 | PMID = 19576193 }}</ref> | *TSH-receptor antibody +ve.<ref name=pmid19576193>{{Cite journal | last1 = Massart | first1 = C. | last2 = Gibassier | first2 = J. | last3 = d'Herbomez | first3 = M. | title = Clinical value of M22-based assays for TSH-receptor antibody (TRAb) in the follow-up of antithyroid drug treated Graves' disease: comparison with the second generation human TRAb assay. | journal = Clin Chim Acta | volume = 407 | issue = 1-2 | pages = 62-6 | month = Sep | year = 2009 | doi = 10.1016/j.cca.2009.06.033 | PMID = 19576193 }}</ref> | ||
*+/-Exophthalmos (bulging eyes). | *+/-Exophthalmos (bulging eyes). | ||
===Hyperthyroidism=== | |||
Mnemonic ''hyperTHYROIDISM'':<ref name=Ref_TN2006_E24>{{Ref TN2006|E24}}</ref><ref>URL: [http://www.prep4usmle.com/forum/thread/6731/2/ http://www.prep4usmle.com/forum/thread/6731/2/]. Accessed on: 1 May 2012.</ref> | |||
*Tremor. | |||
*Heart rate elevated, palpitations. | |||
*Yawn (fatigue). | |||
*Restlessness. | |||
*Oligomenorrhea, amenorrhea. | |||
*Intolerance to heat. | |||
*Diarrhea. | |||
*Irritable. | |||
*Sweating. | |||
*Muscle wasting/weight loss. | |||
==Gross== | ==Gross== | ||
Features:<ref>{{Ref EP|30}}</ref> | Features: | ||
*Enlarged 50-150 g. | *Classic appearance:<ref name=Ref_EP30>{{Ref EP|30}}</ref> | ||
*"Beefy-red" appearance, looks like raw beef. | **Enlarged 50-150 g. | ||
**"Beefy-red" appearance, looks like raw beef. | |||
*May have scattered white nodules (lymphocytes). | |||
==Microscopic== | ==Microscopic== | ||
| Line 54: | Line 69: | ||
*Classic: | *Classic: | ||
**Hypercellular | **Hypercellular | ||
**Patchy lymphocytes. | **Patchy lymphocytes.<ref name=pmid6129766>{{Cite journal | last1 = Leövey | first1 = A. | last2 = Bakó | first2 = G. | last3 = Sztojka | first3 = I. | last4 = Bordán | first4 = L. | last5 = Szabó | first5 = T. | last6 = Kálmán | first6 = K. | last7 = Balázs | first7 = C. | title = The pathogenetic connection between Graves' disease and chronic lymphocytic thyroiditis. (The role and incidence of thyroid stimulating antibodies). | journal = Acta Med Acad Sci Hung | volume = 39 | issue = 1-2 | pages = 1-6 | month = | year = 1982 | doi = | PMID = 6129766 }}</ref> | ||
**Little colloid. | **Little colloid. | ||
*Scalloping of colloid; colloid has undulating border. | *Scalloping of colloid; colloid has undulating border. | ||
| Line 67: | Line 82: | ||
DDx: | DDx: | ||
*[[Papillary thyroid carcinoma]]. | *[[Papillary thyroid carcinoma]]. | ||
*[[Lymphocytic thyroiditis]]. | |||
===Images=== | ===Images=== | ||
| Line 81: | Line 97: | ||
*[http://library.med.utah.edu/WebPath/jpeg4/ENDO022.jpg Graves' disease (med.utah.edu)].<ref>URL: [http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/enfrm.html http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/enfrm.html]. Accessed on: 4 December 2011.</ref> | *[http://library.med.utah.edu/WebPath/jpeg4/ENDO022.jpg Graves' disease (med.utah.edu)].<ref>URL: [http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/enfrm.html http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/enfrm.html]. Accessed on: 4 December 2011.</ref> | ||
*[http://medcell.med.yale.edu/histology/endocrine_systems_lab/graves_disease.php Graves' disease & normal thyroid (yale.edu)]. | *[http://medcell.med.yale.edu/histology/endocrine_systems_lab/graves_disease.php Graves' disease & normal thyroid (yale.edu)]. | ||
==Sign out== | |||
===History provided=== | |||
<pre> | |||
Total Thyroid, Total Thyroidectomy: | |||
- Lymphocytic thyroiditis compatible with Graves' disease. | |||
- One benign lymph node (0/1). | |||
- NEGATIVE for malignancy. | |||
</pre> | |||
==See also== | ==See also== | ||
Latest revision as of 12:43, 21 April 2016
| Graves' disease | |
|---|---|
| Diagnosis in short | |
 Graves' disease. H&E stain. (WC) | |
|
| |
| LM | hypercellular appearance with patchy lymphocytes, little colloid that is scalloped, +/-nuclear clearing, +/-papillae |
| LM DDx | papillary thyroid carcinoma |
| Gross | "beefy-red" appearance, enlarged, +/-white nodules |
| Site | thyroid gland |
|
| |
| Associated Dx | papillary thyroid carcinoma |
| Signs | exophthalmos, signs of hyperthyroidism (tremor, muscle wasting, weight loss, tachycardia, sweating) |
| Symptoms | symptoms of hyperthyroidism (palpitations, fatigue, restlessness, oligomenorrhea, amenorrhea, intolerance to heart, diarrhea, irritability) |
| Prevalence | uncommon |
| Blood work | TSH-receptor antibody - required |
Graves' disease, also Graves disease, is an autoimmune disease that leads to hyperthyroidism.
It is often misspelled "Grave's disease".
General
- Clinical diagnosis.
- Autoimmune disease leading to hyperthyroidism.
- Eye problems not resolved with thyroid removal.[citation needed]
- Increased risk of papillary thyroid carcinoma compared to general population.[1]
Clinical:
- TSH-receptor antibody +ve.[2]
- +/-Exophthalmos (bulging eyes).
Hyperthyroidism
Mnemonic hyperTHYROIDISM:[3][4]
- Tremor.
- Heart rate elevated, palpitations.
- Yawn (fatigue).
- Restlessness.
- Oligomenorrhea, amenorrhea.
- Intolerance to heat.
- Diarrhea.
- Irritable.
- Sweating.
- Muscle wasting/weight loss.
Gross
Features:
- Classic appearance:[5]
- Enlarged 50-150 g.
- "Beefy-red" appearance, looks like raw beef.
- May have scattered white nodules (lymphocytes).
Microscopic
Features:
- Classic:
- Hypercellular
- Patchy lymphocytes.[6]
- Little colloid.
- Scalloping of colloid; colloid has undulating border.
- Non-specific finding.
- +/-Nuclear clearing.
- +/-Papillae (may mimic papillary thyroid carcinoma in this respect).
Notes:
- Usually has an unimpressive appearance... as it is treated, i.e. history is important.
- Nuclear clearing and papillae are usu. diffuse in Graves' disease - unlike in papillary thyroid carcinoma.
DDx:
Images
GD - low mag. (WC)
GD - intermed. mag. (WC)
GD - high mag. (WC)
GD - low mag. (WC)
GD - intermed. mag. (WC)
GD - high mag. (WC)
www:
Sign out
History provided
Total Thyroid, Total Thyroidectomy: - Lymphocytic thyroiditis compatible with Graves' disease. - One benign lymph node (0/1). - NEGATIVE for malignancy.
See also
References
- ↑ Ergin, AB.; Saralaya, S.; Olansky, L.. "Incidental papillary thyroid carcinoma: clinical characteristics and prognostic factors among patients with Graves' disease and euthyroid goiter, Cleveland Clinic experience.". Am J Otolaryngol 35 (6): 784-90. doi:10.1016/j.amjoto.2014.04.013. PMID 25128909.
- ↑ Massart, C.; Gibassier, J.; d'Herbomez, M. (Sep 2009). "Clinical value of M22-based assays for TSH-receptor antibody (TRAb) in the follow-up of antithyroid drug treated Graves' disease: comparison with the second generation human TRAb assay.". Clin Chim Acta 407 (1-2): 62-6. doi:10.1016/j.cca.2009.06.033. PMID 19576193.
- ↑ Shiau, Carolyn; Toren, Andrew (2006). Toronto Notes 2006: Comprehensive Medical Reference (Review for MCCQE 1 and USMLE Step 2) (22nd edition (2006) ed.). Toronto Notes for Medical Students, Inc.. pp. E24. ISBN 978-0968592861.
- ↑ URL: http://www.prep4usmle.com/forum/thread/6731/2/. Accessed on: 1 May 2012.
- ↑ Thompson, Lester D. R. (2006). Endocrine Pathology: A Volume in Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 30. ISBN 978-0443066856.
- ↑ Leövey, A.; Bakó, G.; Sztojka, I.; Bordán, L.; Szabó, T.; Kálmán, K.; Balázs, C. (1982). "The pathogenetic connection between Graves' disease and chronic lymphocytic thyroiditis. (The role and incidence of thyroid stimulating antibodies).". Acta Med Acad Sci Hung 39 (1-2): 1-6. PMID 6129766.
- ↑ URL: http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/enfrm.html. Accessed on: 4 December 2011.