title: Autoimmune thyrotoxicosis: diagnostic challenges.
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.
authors.affiliation: Gutenberg University Medical Center, Department of Ophthalmology, Mainz, Germany.
authors.forename: Katharina A
authors.initials: KA
authors.lastname: Ponto
authors.forename: George J
authors.initials: GJ
authors.lastname: Kahaly
mesh_terms: D001323:Autoantibodies / Q000097:blood*; D015551:Autoimmunity; D005260:Female; D006111:Graves Disease / Q000276:immunology; D006801:Humans; D006965:Hyperplasia / Q000276:immunology; D006980:Hyperthyroidism / Q000276:immunology; D011989:Receptors, Thyrotropin / Q000276:immunology*; D012737:Sex Factors; D013961:Thyroid Gland / Q000276:immunology / Q000473:pathology*; D013967:Thyroiditis, Autoimmune / Q000150:complications / Q000175:diagnosis* / Q000235:genetics / Q000276:immunology; D013971:Thyrotoxicosis / Q000150:complications / Q000175:diagnosis* / Q000276:immunology*
chemical_list: D001323:Autoantibodies; D011989:Receptors, Thyrotropin