**5. Diagnosis**

*Goiter - Causes and Treatment*

**2.11 Reproductive function**

**Figure 2.**

**3. Graves' disease**

**3.1 Presentation**

**4. Pathogenesis**

gynecomastia and erectile dysfunction.

*Patient of Graves disease showing diffuse goitre and eye signs.*

Menstrual irregularity is common. Fertility may be reduced, and if conception takes place, there is an increased risk of miscarriage [16, 17]. The increased rate of conversion of androgens to estrogenic by-products may be the mechanism for

Popularly known as Robert Graves' disease in English speaking world and as Von Basedow's disease in Europe, although disease was first described by Parry in 1825 [11].

Graves' disease characteristics include goitre and thyrotoxicosis; common associated features include orbitopathy (GAO) and dermopathy. The thyroid histology suggests autoimmune thyroiditis with the presence of lymphocytic infiltrate.

The TSHR is a G protein coupled receptor. The TSHR is the primary auto antigen of Graves' disease, experimentally proven with mice antigen antibody studies [18].

**4.1 The major antigen of Graves' disease: the thyrotropin receptor**

**50**

It is always better to test TSH and T4 rather than testing TSH alone, measuring both T4 & TSH increases diagnostic accuracy. In case of overt hyperthyroidism T3 and T4 are high and TSH is low and in subclinical disease T4 is usually normal TSH is usually suppressed, and T3 is normal or increased.

TSH-Receptor-Ab (TRAb) is a specific biomarker for Grave's Disease. Immunoassays used nowadays do competitive assays which measure Thyroid Receptor binding inhibitory immunoglobulins (TBII) [19]. Bioassays can differentiate between blocking and stimulating TRAB but its time consuming and a costly affair.
