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GRAVES' DISEASE
Graves' disease is an autoimmune disorder that results into overproduction of thyroid hormones.
Thyrotoxicosis signs and symptoms include hyperactivity, irritability, insomnia, dysphoria, sweating, heat intolerance, palpitations, weakness, fatigue, weight loss despite increased appetite, diarrhea, steatorrhea polyuria, decreased libido, tachycardia, tremor, goiter, alopecia, gynecomastia, eyelid lag or retraction and rarely periodic paralysis.
Clinical features in thyrotoxic patient that suggests Graves's disease are ophthalmopathy, thyroid dermopathy, thyroid acropachy, diffuse goiter, antibodies to thyroid peroxidase or thyroglobulin and thyroid radionuclide scan demonstrating a diffuse goiter.

Evaluation

Two Step Process
 Confirmation of thyrotoxicosis
  • Measure undetectable TSH by immunoradiometric assay
  • Confirm w/ measurement of FT4
    • FT4 is high in thyrotoxicosis
    • If FT4 is normal, FT3 should be measured because FT3 is elevated at the beginning of most episodes of thyrotoxicosis
  • For patients w/ normal TSH & FT4 levels, no further testing for thyrotoxicosis is needed
Clinical features in thyrotoxic patient that suggest Graves’ disease:
  • Ophthalmopathy
  • Thyroid dermopathy
  • Thyroid acropachy
  • Diffuse goiter
  • Antibodies to thyroid peroxidase (TPO) or thyroglobulin are present in 80% of Graves’ patients
    • Easily measured & may be used if assays for TSH-receptor antibodies are not available
  • Thyroid radionuclide scan demonstrating a diffuse goiter may suggest Graves’ disease
    • May be indicated to distinguish Graves’ hyperthyroidism from thyrotoxicosis
  • Radioactive iodine uptake is indicated when the diagnosis is in question & distinguishes causes of thyrotoxicosis having elevated or normal uptake over the thyroid gland from those w/ near-absent uptake
    • Elevated in patients w/ Graves’ disease & the pattern is diffuse
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