Graves Disease Flashcards
What is Grave’s disease?
- the most common cause of hyperthyroidism due to an autoimmune disease that is associated with an increased circulation of thyroid auto-antibodies leading to increased thyroid hormones
- It is most common in women
What is the triad of graves disease?
- Diffuse vascular goitre
- Ophthalmopathy
- Pretibial myxedema
What is the aetiology of Graves disease?
1.Genetic predisposition:
50% of patients have a family history of autoimmune disease(pernicious anaemia, Hashimotos disease)
HLA-DR3, HLA-B8 alleles
2. Triggers: pregnancy, stress(psychological or surgery, trauma)
3.
What are the clinical features of Graves disease?
- Symptoms of hyperthyroidism
- Triad of Graves disease
- ophthalmopathy(exophthalmos, ocular motility disturbances, lid retraction and conjunctival problems
- pretibial myxedema(non pitting oedema with firm plaques on the anterior or lateral aspect of the legs)
- diffuse goitre
How do we diagnose graves disease?
- We diagnose it using thyroid scintigraphy which shows how the iodine is being taken up in the thyroid
- Best initial test
- Thyroid antibodies
What is the treatment of graves disease?
- anti-thyroid drugs like methimazole, propylthiouracil
- mostly useful in patients that have mild disease
- major side effects: hepatitis, agranulocytosis
- minor side effects: rash, arthralgia - B-blockers for symptomatic treatment
- radioactive iodine ablation
- thyroidectomy
In what other conditions can Graves ophthalmopathy occur?
- hyperthyroidism
- Hashimotos thyroiditis
- Thyroid cancer
What are the risk factors for graves opthalmopathy?
smoking
What is the treatment for graves opthalmopathy?
- smoking cessation
- Eye protection(prevent drying)
- High dose of IV steroids(prednisone)
- Orbital radiation
What are the signs of hyperthyroidism?
- tremor
- tachycardia
- restlessness
- intolerance to heat
- sweating
- diarrhea
- irritability and anxiety
- weight loss
- fatigue
What is the complication of thyroidectomy?
- hypoparathyroidism and vocal cord injury due to the laryngeal nerve palsy
What is the differential diagnosis of Graves?
- Toxic nodular goitre- nodules
2.
what is primary hyperthryroidism?
It is when there is an actual problem with the thyroid
-It produces increased TSH
What is secondary hyperthyroidism?
This is when the problem is in the hypothalamus, or pituatary gland but not the thyroid
What is exophthalmos?
bulging of the eyes from the orbit because of the hypertrophy of the muscle behind the eyes
