Immunhyperthyreose (M. Basedow)

The disease was first described in 1840 by Karl von Basedow.

Graves’ disease or Basedow’s disease is an autoimmune disease in which not only the thyroid gland but also other organs are affected. The disease is a multifactorial process. There is a genetically determinable immune defect that can be aggravated by stress, environmental factors, infections, and smoking.

This autoimmune disease is the most common cause of an overactive thyroid gland in young people and most frequently occurs between the ages of 20 and 40.

With Graves’ disease, there is typically elevated titer of antibodies against the thyroid gland, such as TSH receptor antibodies (TRAK), and also of TPO antibodies and TG antibodies. 

TSH-R-AK (TRAK) are directed against the TSH receptors in the thyroid gland: they have an effect similar to that of TSH and thus simulate the thyroid gland. The complaints, like those described for hyperactivity, are restlessness, rapid heartbeat, and weight loss, as well as hypersensitivity to heat.

Additional complaints and symptoms relating to other organs are endocrine orbitopathy, pretibial myxedema, and acropathy.



1. Drug therapy with thyrostatic medication (Thiamazole, Carbinmazole, Perchlorate) can effectively reduce existing thyroid overactivity and thus the patient’s complaints. In 40-50% percent of cases, a cure is also possible using drug therapy.

Drug treatment lasts for 12-18 months. With short-term therapy lasting less than 6 months, the relapse rate is very high. Premature interruption of therapy should therefore be avoided whenever possible.

In order to quickly bring heart and circulation complaints under control (rapid heartbeat, high blood pressure), beta blockers such as Propoanolol (Inderal) are administered. They not only bring these complaints under control, they also have a sedative effect, which can be an advantage with the restlessness caused by hyperthyroidism. In addition, they reduce the transformation of T4 into the 10-times more effective T3 that takes place in body tissue.


2. In the following cases, surgical removal of the thyroid gland is indicated:

  • Unsuccessful drug therapy
  • A relapse after 12-18 months of thyrostatic therapy.
  • Thyrotoxic crisis
  • Thyrostatic medication intolerance
  • Simultaneous presence of cold nodes
  • Simultaneous suspicion of malignant lesions
  • Very large thyroid gland with mechanical complications such as pressure on the trachea or esophagus.
  • Pronounced endocrine orbitopathy
  • In children and young people
  • The patient’s express wish

The aim of the operation is complete removal of the thyroid gland. After the operation, there is a lifelong need to take the thyroid hormone T4.


3. Radioiodine therapy

  • Relapse after 12 to 19 months of Thyrostatic therapy
  • Thyrostatic medication intolerance
  • Smaller thyroid gland (< 60 ml) without cold nodes
  • Older patients who are susceptible to complications after surgery
  • An express wish on the patient’s part

The aim of radiotherapy is complete deactivation of the thyroid gland. A patient must therefore take the thyroid hormone T4 for the rest of his life following surgery.

The following circumstances are contraindications for radioiodine therapy:

  • Pregnancy
  • Breastfeeding
  • Wish to become pregnant within the next six months