Graves Disease

Question 1

Definition

Answer 1

DEFINITION: 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

Causes

Answer 2

Caused by the presence of TSH-receptor stimulating antibodies

These antibodies are also responsible for the special features of Graves disease (exophthalmos, pretibial myxoedema)

Risk Factors for Hyperthyroidism

• Family history
• High iodine intake
• Smoking
• Trauma to the thyroid gland
• Toxic multinodular goitre
• HAART
• Childbirth

Question 3

Epidemiology

Answer 3

Hyperthyroidism is COMMON

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

Rarely occurs in children

Question 4

Symptoms

Answer 4

Weight loss despite increased appetite

Irritability

Weakness

Diarrhoea

Sweating

Tremor

Anxiety

Heat intolerance

Loss of libido

Oligomenorrhoea/amenorrhoea

Question 5

Signs

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

Investiigations

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

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