Graves' disease

Question 1

Define:

Answer 1

Most common cause of hyperthyroidism due to TSH receptor binding autoantibodies.

Question 2

Aetiology:

Answer 2

TSH stimulating autoantibodies leads to loss of negative feedback and large release of T3/4.

This leads to a smoothly enlarged goitre

These autoantibodies lead to the special features of Graves’.

Question 3

Risk factors:

Answer 3

Childbirth 
HAART
High iodine intake 
Smoking
Family history 
Autoimmune conditions - Vitiligo, Addison's, T1DM
Toxic multinodular goitre

Triggers - stress, infection and childbirth

Question 4

Epidemiology:

Answer 4

Hyperthyroidism is common

Graves is the most common cause of hyperthyroidism (75%)

Rare in children

Question 5

Symptoms:

Answer 5

EVERYTHING SPEEDS UP

Decreased weight but increased appetite

Sweating

Anxiety

Heat intolerance

Tremor

Weakness

Irritability

Loss of libido

Ammenorrhea/oligiorrhea

Question 6

Signs:

Answer 6

Tachycardia (AF)

Palmar erythema

Thin hair

Smoothly enlarged goitre

Lid lag

Expathalamos

Proximal myopathy

Pretibial myxoedema

Brisk reflexes

Uticaria / pruritus

sweaty warm palms

fine tremor

gynaecosmastia

orphthalmoplegia

thyroid acropathy

Question 7

Investigations:

Answer 7

TFTs = low TSH

High T3/4

Autoantibodies:

• Anti TPO
• Anti thyroglobulin
• TSH receptor (this is very specific and sensitive)

Imaging - thyroid ultrasound, radioisotope uptake

Inflammatory markers - CRP/ESR (these should be low in graves but raises in acute thyroiditis)