[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [General pathology](https://durgical.com/en/general-pathology/) › [Endocrine system](https://durgical.com/en/general-pathology/areas/endocrine/) › Graves disease # Graves disease - Lesion In Graves disease an antibody switches the thyroid on permanently. The gland grows, the body speeds up, and the eyes can bulge. Updated Nov 12, 2026 ## Key points - Thyroid-stimulating immunoglobulin (TSI) binds the TSH receptor: a type II hypersensitivity that stimulates instead of destroying. - Triad: hyperthyroidism with diffuse goitre, infiltrative ophthalmopathy (exophthalmos), localised dermopathy (pretibial myxoedema). - Microscopy: tall columnar crowded follicular cells forming papillae without fibrovascular cores, pale scalloped colloid, lymphoid infiltrates. - Ophthalmopathy: orbital fibroblasts express the TSH receptor; T cells, cytokines and glycosaminoglycans swell the muscles and fat. - Genetics: HLA-DR3, CTLA4, PTPN22; associated with other autoimmune diseases. - TSI cross the placenta: neonatal thyrotoxicosis. ## What it is Graves disease is the commonest cause of endogenous hyperthyroidism. Autoantibodies against the TSH receptor mimic TSH, so the gland becomes diffusely hyperplastic and overactive. The same autoimmune process inflames the orbit and the pretibial skin, producing the triad of thyrotoxicosis, ophthalmopathy and dermopathy. It is more common in women, peaks in young to middle adulthood, and shares genetic risk with other autoimmune diseases. ## Structure - Gross: symmetric, diffusely enlarged, soft, beefy-red gland with an intact capsule. - Follicular cells are tall and crowded and fold into small papillae; colloid is pale with scalloped (resorption) edges. - Lymphoid aggregates and occasional germinal centres in the stroma. - Orbit: oedematous extraocular muscles with lymphocytes, glycosaminoglycans and later fibrosis. - Dermopathy: thick dermis with glycosaminoglycans and lymphocytes over the shins. ## Step by step - Loss of tolerance to the TSH receptor in a genetically susceptible person. - B cells produce TSI that bind and activate the receptor like TSH. - cAMP rises in thyrocytes: growth (diffuse hyperplasia) and excess T4 and T3. - High hormone suppresses pituitary TSH, but TSI keep driving the gland. - Orbital and dermal fibroblasts with TSH receptor respond to the same immune attack: proptosis and pretibial myxoedema. ## Clinical notes - Exophthalmos, lid retraction and stare; severe cases risk corneal exposure and optic nerve compression. - Smoking worsens orbitopathy; radioiodine can also worsen it. - Thyroid storm is the life-threatening extreme. ## Memory aid Graves antibodies are counterfeit keys to the TSH lock: the door never shuts, and the same key fits the locks behind the eyes and on the shins. ## Test yourself Think of the answer, then tap the question to see it. ## Why are there papillae without fibrovascular cores in Graves disease? The hyperplastic, crowded follicular epithelium folds into the lumen; they lack cores, unlike true papillae of papillary carcinoma. ## How does Graves ophthalmopathy develop? Orbital fibroblasts and preadipocytes express the TSH receptor; autoreactive T cells and cytokines stimulate them to make glycosaminoglycans and fat, swelling the orbit. ## Which type of hypersensitivity is Graves disease? Type II (antibody-mediated), with stimulating rather than destructive antibodies. [Add to my cards (3)](https://durgical.app/estudiar/?add=/en/general-pathology/graves-disease/) [More Pathology questions →](https://durgical.com/en/practice/?f=pathology) ## Elsewhere in DurgiPedia - [Type II hypersensitivity (antibody against cells)](https://durgical.com/en/immunology/type-ii-hypersensitivity/) - [Autoantibodies: the table to know](https://durgical.com/en/immunology/autoantibodies-the-table-to-know/) - [Actions of thyroid hormones](https://durgical.com/en/physiology/actions-of-thyroid-hormones/) - [Hyperplasia: physiologic and pathologic](https://durgical.com/en/general-pathology/hyperplasia-physiologic-and-pathologic/) ## Connections ## Related 4 - [Thyrotoxicosis: causes](https://durgical.com/en/general-pathology/thyrotoxicosis-causes/) - [Hashimoto thyroiditis](https://durgical.com/en/general-pathology/hashimoto-thyroiditis/) - [Goitre: diffuse and multinodular](https://durgical.com/en/general-pathology/goitre-diffuse-and-multinodular/) - [Hyperplasia: physiologic and pathologic](https://durgical.com/en/general-pathology/hyperplasia-physiologic-and-pathologic/) ## Related conditions 4 - [Graves disease (hyperthyroidism)](https://durgical.com/en/conditions/graves-disease/) - [Thyroid eye disease (Graves orbitopathy)](https://durgical.com/en/conditions/thyroid-eye-disease/) - [Thyroid storm](https://durgical.com/en/conditions/thyroid-storm/) - [Myasthenia gravis](https://durgical.com/en/conditions/myasthenia-gravis/) [← All of general pathology](https://durgical.com/en/general-pathology/) Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given. Sources: [Graves Disease](https://www.ncbi.nlm.nih.gov/books/NBK448195/) (StatPearls (NCBI Bookshelf), 2025); [Graves' disease](https://medlineplus.gov/genetics/condition/graves-disease/) (MedlinePlus, US National Library of Medicine, 2025). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/general-pathology/graves-disease/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/general-pathology/graves-disease/