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13 Graves disease and Hashimoto s thyroiditis are autoimmune thyroid diseases. Graves disease causes hyperthyroidism. Hashimoto s thyroiditis causes hypothyroidism. They are more common in women than in men. Graves disease and Hashimoto s thyroiditis have a genetic component because they can run in families. In autoimmune thyroid diseases, the immune system mistakes thyroid tissue as a foreign and potentially dangerous invader of the body and attacks it. Over stimulation of the thyroid gland and increased production of thyroid hormones (hyperthyroidism) is the hallmark of Graves disease. Hyperthyroidism results in the increases of metabolism. This results in symptoms, such as nervousness, anxiety, and palpitation. Decreased production of thyroid hormones (hypothyroidism) is the hallmark of Hashimoto s thyroiditis. Hypothyroidism results in a slowing of the body s chemical processes and metabolism. This results in symptoms, such as weight gain, fatigue, and depression. Making a diagnosis of autoimmune thyroid diseases begins with taking a thorough medical history, including symptoms, and completing a physical examination. A physician may feel a goiter in the neck upon an examination. A blood test is performed to determine levels of TSH and thethyroidhormones (thyroxine: T4 and triiodothyronine: T3). Low levels of TSH and high levels of T4 indicate hyperthyroidism and may indicate a diagnosis of Graves disease. High levels of TSH and low levels of T4 indicate hypothyroidism and may indicate a diagnosis of Hashimoto s thyroiditis. Graves disease is an autoimmune disease characterized by hyperthyroidism due to circulating thyroid stimulating antibodies (TSAb). TSAb are TSH receptor antibodies (TRAb), which bind to and activate thyrotropin receptors, causing the thyroid gland to grow and the thyroid follicles to increase synthesis of thyroid hormone. Hashimoto s thyroiditis is characterized by the destruction of thyroid follicle cells by various cell- and antibody-mediated immune processes. Patients with Hashimoto s thyroiditis may have antibodies (Ab) to various thyroid antigens; antithyroid peroxidase Ab (TPOAb), antithyroglobulin Ab (TGAb), and TSH-stimulation blocking Ab (TSBAb)(TRAb). There are two types of TRAb; TSAb and TSBAb. TSAb causes Graves hyperthyroidism. TSBAb causes hypothyroidism. Anti-thyroid drugs (ATDs) (MMI, PTU) are used for the treatment of Graves hyperthyroidism. T4 is used for the treatment of hypothyroidism.

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Medical Journal of Aizawa Hospital

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