Graves' Disease Flashcards
Describe Graves’
Most common cause of hyperthyroidism - TSH-receptor stimulating auto-antibodies lead to hyperthyroidism - loss of negative feedback.
What are the causes/risk factors of Graves’?
- TSH-receptor stimulating Ab bind to and activate G-protein coupled thyrotrophin receptors causing smooth thyroid enlargement and ↑ T3/T4 production.
- Ab responsible for the special features of Graves’ disease (exophthalmos, pretibial myxoedema)
Risk Factors:
• FHx
• ↑ Iodine intake
• Smoking
• Trauma to the thyroid gland
• goitre – toxic multi-nodular
• HAART – Highly Active Antiretroviral therapy – treating HIV
• Childbirth
• AI diseases: vitiligo, T1DM, Addison’s
• Triggers: Stress, infection, childbirth
What are the symptoms of Graves’?
- Blurred vision
- Double vision
- Weight loss despite increased appetite
- Irritability
- Weakness
- Diarrhoea
- Sweating
- Tremor
- Anxiety
- Heat intolerance
- Loss of libido
- Oligomenorrhoea/amenorrhoea
- Gynaecomastia in males
What are the signs of Graves’?
- Palmar erythema
- Sweaty and warm palms
- Thin hair
- Fine tremor
- Tachycardia (may be AF)
- Hair thinning
- Urticaria/pruritus
- Brisk reflexes
- Goitre
- Proximal myopathy
- Lid lag: eyelid lags behind eye’s descent as patient watches your finger descend
- Gynaecomastia
- Specific to Graves’: exophthalmos, ophthalmoplegia, pretibial myxoedema (oedematous swellings above lateral malleoli), thyroid acropachy (extreme manifestation with clubbing, painful finger and toe swelling, periosteal reaction in limb bones)
What investigations are carried out for Graves’?
• 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 radioisotope uptake scan
• Inflammatory Markers - CRP/ESR will be raised in subacute thyroiditis – not Graves’
