Graves' disease

Question 1

Define Graves disease

Answer 1

The most common cause of hyperthyroidism. Caused by the presence of TSH-receptor stimulating antibodies that lead to hyperthyroidism due to loss of negative feedback.

Question 2

Explain the aetiology/risk factors of Graves disease

Answer 2

Caused by the presence of TSH-receptor stimulating antibodies

Risk Factors for Hyperthyroidism
Family history
High iodine intake
Smoking
Trauma to the thyroid gland
Toxic multinodular goitre
HAART
Childbirth

Question 3

Summarise the epidemiology of Graves disease

Answer 3

Hyperthyroidism is COMMON
Graves’ is the most common cause of hyperthyroidism (75%)
Rarely occurs in children

Question 4

Recognise the presenting symptoms of Graves disease

Answer 4

Weight loss despite increased appetite
Irritability
Weakness
Diarrhoea
Sweating
Tremor
Anxiety
Heat intolerance
Loss of libido
Oligomenorrhoea/amenorrhoea

Question 5

Recognise the signs of Graves disease on physical examination

Answer 5

Palmar erythema
Sweaty and warm palms
Fine tremor
Tachycardia (may be AF)
Hair thinning
Urticaria/pruritus
Brisk reflexes
Goitre
Proximal myopathy
Lid lag
Gynaecomastia

Question 6

Identify appropriate investigations for Graves disease

Answer 6

TFTs-low TSH + high T3/T4

Autoantibodies
Anti-TPO antibodies (thyroid peroxidase) -found in 75% of Graves
Anti-thyroglobulin antibodies
TSH-receptor antibodies- very sensitive and specific for Graves

Imaging
Thyroid ultrasound
Thyroid uptake scan (Tc-99m)

Inflammatory Markers- CRP/ESR will be raised in subacute thyroiditis