Which of the following statements about Grave’s disease is false?

Ref. Sabiston Textbook of Surgery. Pg. 2819   Graves disease is an autoimmune disease caused by the presence of thyroid stimulating immunoglobulin in the plasma resulting in hyperthyroidism . The female : male ratio ranges from 5:1 to 10:1. Diffuse toxic goiter is the major manifestation of Graves disease. Pathogenesis