Graves Flashcards
Define Grave’s?
most common cause of hyperthyroidism
presence of TSH stimulating antibodies leading to hyperthyroidism due to loss of negative feeback
what is the cause of Grave’s disease
IgG antibodies binding to the TSH receptor, this in turn causes excess production of thyroid hormone.
antibodies are responsible for special features of Grave’s- EXOPHTHALMOS, PRETIBIAL MYXOEDEMA, THYROID ACROPACHY
What are the risk factors for hyperthyroidism?
Family history
High iodine intake
Smoking – ophthamology is more common in smokers
Trauma to the thyroid gland
Toxic multinodular goitre
HAART (HIV therapy)
Childbirth
what are the triggers for a thyroid crisis?
surgery from trauma
MI
infection
DKA
Radioactive iodine
summarise the epidemiology of grave’s disease?
hyperthyroidism is common
Grave’s is most common cause of hyperthyroidism
rarely occurs in children
what are the symptoms of hyperthyroidism?
Weight loss despite increased appetite
Irritability
Weakness
Diarrhoea
Sweating
Tremor
Anxiety
insomnia
Heat intolerance
Loss of libido
Oligomenorrhoea/amenorrhoea
what are the signs of hyperthyroidism?
- Palmar erythema
- Sweaty and warm palms
- Fine tremor
- Tachycardia (may be AF)
- Hair thinning
- Urticaria/pruritus
- Brisk reflexes
- Goitre - swelling in the neck
- Proximal myopathy
- Lid lag
- Gynaecomastia
- Exophthalmos
- pretibial myxoedema
- thyroid bruit
what are the investigations for grave’s?
TFTs - low TSH + high T3/T4
Autoantibodies
- Anti-TPO antibodies (thyroid peroxidase) - found in 75% of Graves - can also be seen in Hashimoto’s
- Anti-thyroglobulin antibodies
- TSH-receptor antibodies- very sensitive and specific for Graves
Imaging
- Thyroid ultrasound
- Thyroid uptake scan - diffuse
Inflammatory Markers - CRP/ESR will be raised in subacute thyroiditis
SIDE NOTE: A biopsy will show tall follicles with scalloped borders.
what is grave’s triad?
- Exopthalmos
- Thyroid Acropachy
- Pretibial Myxoedema
what is thyroid acropachy?
soft tissue swelling of the hands and feet, clubbing and periosteal growth.
How does Grave’s lead to exophthalmos and pretibial myxoedema, and thyroid acropachy?
The antibodies bind to other areas of the body such as the extraocular muscles leading to gaze abnormalities, the shins causing raised lesions known as ‘pretibial myxoedema’ and rarely the fingers causing clubbing known as ‘thyroid acropachy’
