Grave's Disease

Question 1

Graves’ disease is the most common cause of thyrotoxicosis. TRUE/FALSE?

Answer 1

TRUE

Question 2

What patient demographic normally develops Grave’s Disease

Answer 2

Women
Aged 30-50

Question 3

What features are seen in Grave’s disease but NOT in other forms of thyrotoxicosis?

Answer 3

• EYE signs
  > exophthalmos
  ? ophthalmoplegia
• pretibial myxoedema
• thyroid acropachy triad:
  > finger clubbing
  > soft tissue swelling of the hands and feet
  > periosteal new bone formation

Question 4

What antibodies can be found in patient’s with Grave’s disease

Answer 4

TSH receptor stimulating antibodies (90%)

anti-thyroid peroxidase (anti-TPO) antibodies (75%)

Question 5

What is seen on thyroid imaging in Grave’s?

Answer 5

diffuse, homogenous, increased uptake of radioactive iodine

Question 6

What are the main treatment options in Grave’s disease?

Answer 6

Propranolol - for symptomatic relief
Anti-thyroid drugs (e..g Carbimazole)
Radio-iodine
Surgery

Question 7

What dose is carbimazole usually started at?

Answer 7

40mg

Question 8

How long is carbiimazole continued for?

Answer 8

12-18 months

Question 9

What is the main side effect of carbimazole?

Answer 9

agranulocytosis

Question 10

When is radioiodine used to treat Grave’s disease?

Answer 10

• if patient’s relapse after anti-thyroid therapy
• resistant to anti-thyroid drugs

Question 11

What are the potential contraindications for radioiodine treatment?

Answer 11

• age <16
• pregnancy
  (also avoid becoming pregnant for 4-6 months following treatment)
• Thyroid eye disease = relative contraindication (may worsen)

Question 12

The majority of patients who have radioiodine treatment will require thyroxine supplementation after 5 years. TRUE/FALSE?

Answer 12

TRUE

most will become hypothyroid and require thyroxine