Graves' Disease

Question 1

40 female, weight loss (1 stone in 2 weeks) + irritability. Normal appetite. Complains of blurry vision over last month. On exam, she has a “staring look” with lid lag and lid retraction - what features here suggest thyrotoxicosis and/or Graves’ specifically?

Answer 1

Thyrotoxicosis (any cause)

• weight loss + normal appetite
• irritability
• lid lag
• lid retraction

Graves’ disease

• ‘staring look’ (proptosis)
• diplopia (blurred vision)

Question 2

Common symptoms of thyrotoxicosis?

Answer 2

Weight loss w/ normal/increased appetite
Heat intolerance 
Palpitations
Tremor
Irritability

Question 3

What 2 signs are present for any cause of thyrotoxicosis?

Answer 3

Lid lag

Lid retraction

Question 4

Specific signs/symptoms or Graves’ disease?

Answer 4

Periorbital oedema
Conjunctival irritation
Exophthalmos
Diplopia

Question 5

Pathophysiology of Graves’ disease?

Answer 5

Autoimmune condition where circulating IgG immunoglobulins stimulate TSH receptors on the thyroid gland, stimulating it, extraphysiologically, to produce/release thyroxine into the circulation

Question 6

Which organ does Graves’ affect particularly and why?

Answer 6

The eye
- autoantibodies are directed against retro-orbital structures causing:
- proptosis (protrusion of the eye)
- ophthalmoplegia (paralysis of eye movement muscles)
- periorbital oedema
These are specifically linked to Graves’ disease, rather than the thyrotoxicosis caused by Graves’ itself