Graves' disease Flashcards
Define Graves’ Disease
Autoimmune thyroid condition associated with hyperthyroidism
Aetiology of Graves’ Disease
Circulating IgG antibodies bind to activate G-protein-coupled thyrotrophin receptors/TSH receptors -> smooth thyroid enlargement + increased hormone production (esp. T3)
Autoantibodies can also react with orbital antigens
May be triggered by stress, infection and childbirth
Risk factors for Graves’ Disease
Autoimmune diseases (T1DM, vitilgo) Family history of autoimmune disease Female Smoking High iodine intake Lithium therapy Radiation Stress
Epidemiology of Graves’ Disease
Most common form of hyperthyroidism
Highest incidence 40-60
4-9x more common in women
Symptoms of Graves’ Disease
Heat intolerance Diarrhoea Irritability or mood swings Sweating Weight loss (despite increased appetite) Tremor Hair loss Muscle weakness Menstrual irregularity Sexual dysfunction
Signs of Graves’ Disease on examination
Tachycardia Exophthalmos/proptosis Ophthalmoplegia Diffuse goitre Tremor Pretibial myxoedema (oedematous swellign above lateral malleoli) Acropathy (clubbing + soft tissue swelling) Palmar erythema
Investigations for Graves’ Disease
TFTs: T4+T3 elevated, TSH suppressed, T3/T4 ratio elevated
TSH receptor antibodies: +Ve (95%)
Anti-thyroid peroxidase antibodies (75%)
Thyroid isotope scan: smooth uptake
Thyroid USS: highly vascular, diffuse, enlarged
CT/MRI orbit: muccle thickening
Skin biopsy; thyroid dermopathy