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Graves-Basedow disease

Author: Wikipedia, Posted on Wednesday, September 15 @ 22:32:09 IST by RxPG  

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Endocrinology

Graves-Basedow disease is an autoimmune disorder of the endocrine system that stimulates and attacks the thyroid gland, being the most common cause of hyperthyroidism. Also known simply as Graves' disease, it occurs most frequently in women (8:1 compared to men) of middle age. Symptoms include fatigue, weight loss and rapid heart beat.

Because similar antibodies to those attacking the thyroid also affect the eye, blurred vision and eye irritation are also commonly reported. Graves' is a genetic disorder, and while treatable with anti-thyroid medications or removal of the thyroid, Graves' disease is incurable.

Definition

Graves-Basedow disease is a disorder characterized by a triad of hyperthyroidism, goitre, and exophthalmos (bulging eyeballs).
Etiology unknown, it may be related to a malfunction of the immune system. Female dominance, ratio 4: 1; onset is commonly in the third to fifth decades of life.

The severe form of exophthalmos occurs only in a minority of patients with the disorder, and is also known as infiltrative opthalmopathy, Graves' opthalmopathy, or Thyroid Eye Disease (TED).

Signs and symptoms

The symptoms include cardiac arrhythmias, increased pulse rate, weight loss in the presence of increased appetite, intolerance to heat, elevated basal metabolism rate, profuse sweating, apprehension, weakness, elevated protein-bound iodine level, tremor, diarrhoea, headache, vomiting, eyelid retraction, and stare.

Extremely manifested disease that can sometimes be life-threatening is called the thyroid storm (coma).

Historical background

According to Jan-Gustaf Ljunggren, in an article in the Swedish journal Läkartidningen (1983; No 32-33), eponymic priority may be due to a Persian physician. According to Ljunggren, more than eight hundred years ago the Persian physician Sayyid Ismail Al-Jurjani seems to have noted the association of goitre and exophthalmos, in Thesaurus of the Shah of Khwarazm, the most famous of his five books, and the major medical dictionary of its time.

The clinical picture was first noted by Caleb Hillier Parry (1755-1822) in 1786 and reported in his posthumous collection of unpublished writings in 1825. It was first described by the Italians Giuseppe Flajani (1741-1808) in 1802 and Antonio Giuseppe Testa (1756-1814) in 1810. Robert James Graves (1797-1853) of Ireland in 1835, and Karl Adolph von Basedow in 1840. The clinical triad described by Basedow included goiter, exophthalmos, and tachycardia. On the European Continent the term Basedow's disease is the more common, while it is known as Graves' disease in the English-speaking world.

Bibliography

Sayyid Ismail Al-Jurjani: Thesaurus of the Shah of Khwarazm.

G. Flajani: Sopra un tumor freddo nell'anterior parte del collo broncocele. (Osservazione LXVII.). In his: Collezione d'osservazioni e reflessioni di chirurgia. Rome, Michele A Ripa Presso Lino Contedini, 1802. Volume 3, pp 270-273.

A. G. Testa: Delle malattie del cuore, loro cagioni, specie, segni e cura. Bologna, 1810. 2nd edition in 3 volumes, Florence, 1823; Milano 1831; German translation, Halle, 1813.

C. H. Parry: Enlargement of the thyroid gland in connection with enlargement or palpitations of the heart. Posthumous, in: Collections from the unpublished medical writings of C. H. Parry. London, 1825, pp. 111-129. According to Garrison, Parry first noted the condition in 1786. He briefly reported it in his Elements of Pathology and Therapeutics, 1815. Reprinted in Medical Classics, 1940, 5: 8-30.

Robert J. Graves: New observed affection of the thyroid gland in females.(Clinical lectures.) London Medical and Surgical Journal (Renshaw), 1835; 7: 516-517. Reprinted in Medical Classics, 1940, 5: 33-36.

H. Marsh: Dilatation of the cavities of the heart. Enlargement of the thyroid gland. Dublin Journal of Medical and Chemical Science. 1842, 20: 471-474. Abstract.

K. A. von Basedow: Exophthalmus durch Hypertrophie des Zellgewebes in der Augenhöhle. [Casper's] Wochenschrift für die gesammte Heilkunde, Berlin, 1840, 6: 197-204; 220-228. Partial English translation in: Ralph Hermon Major (1884-1970): Classic Descriptions of Disease. Springfield, C. C. Thomas, 1932. 2nd edition, 1939; 3rd editon, 1945.

Die Glotzaugen. [Casper's] Wochenschrift für die gesammte Heilkunde, Berlin, 1848: 769-777.

J. Begbie: Anaemia and its consequences; enlargement of the thyroid gland and eyeballs. Anaemia and goitre, are they related? Monthly Journal of Medical Science, London, 1849, 9: 496-508.




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