Table Of Contents
Graves Disease
Graves disease is an autoimmune thyroid disease caused by thyrotroping-stimulating immunoglobulins (TSIs) which stimulate TSH receptors resulting in elevated basal thyroid activity. Unlike toxic adenoma, 50% of patients with Grave’s disease undergo remission within the first year of treatment. This is why medical treatment, instead of surgery, is preferred for Grave’s disease.
Most common cause of hyperthyroidism. More common in women. Age of onset is on average 20 – 40 years. Associated with other autoimmune disorders (HLA-B8)
- Signs and symptoms
- Hyperthyroid symptoms
- Exophthalmos (deposition of glycosaminoglycans in the retro-orbit) and ophthalmoplegia
- Pretibial myxedema
- Thyroid acropachy
- Physical exam
- Tachycardia
- Goiter
- Warm/moist skin
- Fine tremor
- Investigations
- Thyroid function test: low TSH, high T3 and T4. High T3/T4 ratio suggests Graves disease over thyroiditis.
- Serology for Thyroid-stimulating immunoglobulin (TSI): most accurate test
- TSH receptor stimulating antibodies (90%)
- Anti-thyroid peroxidase antibodies (75%)
- Complete blood count: normocytic anaemia
- Calcium: hypercalcemia (T3 activates osteoclasts
- RAIU scan: diffuse increased uptake
- Medical treatment
- Propranolol to control symptoms
- Propylthiouracil (choose in pregnant women in the first trimester) or Methimazole – antithyroid drugs
- Radioiodine ablation is the definitive treatment
- Steroids and/or Teprotumumab (Tepezza) for Graves ophthalmology and myxedema (may not respond to antithyroid medication)
- Surgical treatment (Indicated if the patient fails to respond to medical treatment)
- Bilateral subtotal thyroidectomy
- Radioactie Iodine ablation
- Contraindications for radioactive iodine ablation
- Pregnant or nursing mothers
- Patients with moderate-to-severe ophthalmopathy
- Patients who smoke (worsens ophthalmopathy)
- Patients with large goiters
- Patients with severe thyrotoxicosis requiring rapid control
- Complications of thyroidectomy
- Thyroid storm
- Hemorrhage
- Hypoparathyroidism
- Recurrent Laryngeal Nerve Injury
