Grave's disease

Question 1

Define Graves disease

Answer 1

Autoimmune disease associated with hyperthyroidism, eye exophthalmos and tibial myxoedema -AB agains TPO and TSH receptors

Question 2

Management of Graves disease

Answer 2

thyroid storm-high dose carbi/polyuracil + B blockers + steroids STAT

B-blockers-symptomatic Mx-propanolol 20-40mg TDS (except in asthma)

Carbimazole 15-40mg OD
(But liver is over active due to hyperThyroid-takes a while to work and often initially destroyed fast (start with higher and go down))
or
Propylthioluracil 200-400mg OD
UK approach tends to be block and replace-kill of thyroid with prolonged use of the drugs (or radio idodine), then give levothyroxine rest of life

Question 3

Aetiology and risk factors of Graves disease

Answer 3

Graves is autoimmune-seems to be caused by combination of genetic (80%) and environemental–but not single gene defects
Graves is an AID with AB against TSH receptors and TPO
TSHR AB activate the TSHR, causing the thyroid to overproduce massively
These AB can also latch in the eye-causing exophtalmos and soft tissue in tubia-causing non pitting oedema

Risk factors :
FHx of Thyroid AID (Hashimoto, etc)
Female
Smoke

Question 4

Epidiemology of Graves disease

Answer 4

Graves if the most common form of hyperthyroidism in most of the world (except those with iodine deficiency)

about 2 in 1000-commonish

Question 5

Signs and Sx of graves disease

Answer 5

can be subclinical and asymptote

Hyperthyroidism
Heat intolerance, sweating, weight loss, increased appetite, moist skin
palpitations, tachycardia, high BP, tremor

hair loss, menstrual changes

Graves specific-
25% have exopthalmos
and pretibial myxedema

Smooth, enlarged goitre

Question 6

Investigations of graves disease

Answer 6

TSH-very low/supressed
T3/T4-high, except in subclinical then normal

Iodine uptake-faster than usual, but no hot nodules

TSHreceptor AB-positive

USS-enlarged, vascular thyroid

Question 7

Complications of Graves disease

Answer 7

Thyroid storm-killer is heart going haywire-

Bone mineral loss

atrial fibrillation (and MI/stroke)

Congestive Heart failure

Sign threatening exophthalmos

Question 8

Prognosis of Graves disease

Answer 8

high increase of CVD death in patient with suboptimal control

prompt treatment and good control nearly entirely removes risk
but can relapse-quite commonly,=-need monitoring