Introduction
Grave’s disease is an autoimmune thyroid disorder characterized
by circulating antibodies that stimulate the TSH receptor, resulting in the increase in synthesis and release of thyroid hormones
-it is the most common cause of hyperthyroidism and thyrotoxicosis
-It is more common in women than in men with onset usually between 20 and 40 years of age
-Dietary iodine supplementation can trigger Graves disease
-Thyrotoxicosis: clinical state resulting from inappropriately high thyroid hormone levels
hyperthyroidism: thyrotoxicosis caused by elevated synthesis and secretion of thyroid hormone
Symptoms & Signs
General: fatigue, fever, heat intolerance, weight change, irritability, intolerance
Thyroid: diffusely enlarged thyroid often with a loud bruit
Eyes: infiltrative ophthalmopathy (Graves exophthalmos),spasm of the upper eyelid revealing the sclera above the corneoscleral limbus (Dalrymple’s sign) , lid lag with downward gaze (von Graefe sign), a staring appearance (Kocher sign), conjunctival swelling and congestion, keratitis, papilledema, permanent visual loss
Nervous: Restlessness, nervousness, fine resting tremors
Cardiac: palpitations, angina,exertional dyspnea, atrial fibrillation, premature atrial contractions, atrial tachycardia, ischemic or valvular heart disease, pulmonary hypertension
Gastrointestinal: dysphagia, frequent bowel movements, diarrhea
Musculoskeletal: muscle weakness, cramps, osteoporosis
Dermatologic: facial flushing, moist warm skin, pruritis, increased sweating, fine hair, onycholysis,bony involvement leads to subperiosteal bone formation and swelling in the metacarpals (thyroid acropachy), infiltrative dermopathy (pretibial myxedema)
Genitourinary: menstrual irregularities amenorrhea, decreased fertility, and an increased incidence of miscarriages
Diagnosis
Serum TSH: low or undetectable
free T4 or T3: elevated
Thyroid receptor antibodies (TRAbs): elevated
RAI scan: elevated uptake and a homogeneous pattern
Technetium scintigraphy: increased or normal thyroid uptake of technetium
Treatment
Symptomatic treatment: beta blockers, calcium blockers
Antithyroid drugs: Methimazole, carbimazole, propylthiouracil
Radioactive iodine (131I, RAI): the most commonly prescribed treatment in the United States, but is contraindicated in pregnancy or with breastfeeding
surgery: a total resection of one lobe and a subtotal resection of the other lobe