Graves' disease: epidemiology, genetic and environmental risk factors and viruses

Graves' disease: epidemiology, genetic and environmental risk factors and viruses:



Publication date: Available online 4 February 2020

Source: Best Practice & Research Clinical Endocrinology & Metabolism

Author(s): Alessandro Antonelli, Silvia Martina Ferrari, Francesca Ragusa, Giusy Elia, Sabrina Rosaria Paparo, Ilaria Ruffilli, Armando Patrizio, Claudia Giusti, Debora Gonnella, Alfonso Cristaudo, Rudy Foddis, Yehuda Shoenfeld, Poupak Fallahi

Abstract

Graves' disease (GD) is the most common cause of hyperthyroidism in developed Countries. It is more common between 30-60 years; 5-10 times more frequent in women. The genetic predisposition accounts for 79% of the risk for GD, while environmental factors for 21%. About 70% of genes associated with autoimmune thyroid disorders (AITD) are implicated in T-cell function. Among GD endogenous factors, estrogens, X-inactivation and microchimerism are important. Among environmental risk factors, smoking, iodine excess, selenium and vitamin D deficiency, and the occupational exposure to Agent Orange have been associated with GD. Many studies showed that HCV is associated with thyroid autoimmunity and hypothyroidism, in patients with chronic HCV hepatitis (CHC); a significant link has been shown also between HCV-related mixed cryoglobulinemia and risk for GD. Moreover, IFN-α-treated CHC patients develop GD more frequently.