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Indeed one or two never appear, and moreover, the three may run courses that are largely independent of one another.
Graves' disease can occur at any age but is unusual before puberty. It most commonly affects the 30 to 50 year age group. The disease is more frequent in women, the ratio of predominance in women may be as high as 7 : 1.
Genetic factors play a role. There is an association between the disease and the genes HLA ( human leucocyte antigen) B8, -DRw3, -Bw36, -Bw46. Indeed, a 50% concordance is found between identical twins. This means that if one individual in an identical pair of twins is afflicted with Graves' disease, the likelihood of the other sibling coming down with Graves' is 50%...
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