Graves'%20disease Diagnosis
Assessment
Clinical Features in Thyrotoxic Patient that Suggest Graves’ Disease:
- Graves' orbitopathy
- Also known as thyroid-associated orbitopathy, thyroid eye disease, and Graves' ophthalmopathy
- Thyroid dermopathy: Pretibial myxedema
- Thyroid acropachy: Digital clubbing and formation of periosteal new bone in the metacarpal bones or phalanges
- Diffuse goiter
Laboratory Tests
Thyroid Function Tests
- Measure undetectable thyroid stimulating hormone (TSH) by immunoradiometric assay (IRMA)
- Initial screening test to evaluate thyrotoxicosis
- Most sensitive and specific blood test to evaluate patients suspected with thyrotoxicosis
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Confirm with measurement of free thyroxine (FT4)
- FT4 is high in thyrotoxicosis
- If FT4 is normal, free triiodothyronine (FT3) should be measured because FT3 is elevated at the beginning of most episodes of thyrotoxicosis
- For patients with normal TSH and FT4 levels, no further testing for thyrotoxicosis is needed
- May be an option for nonpregnant and pregnant hyperthyroid patients without nodular thyroid and overt clinical signs of Graves' disease
- Helps to distinguish Graves' disease from other etiologies of hyperthyroidism; positive antibodies confirm diagnosis of Graves' disease
- May be used to guide definitive therapy and for prediction of risk of relapse for Graves’ disease
- May be an option for nonpregnant hyperthyroid patients with suspicious nodular thyroid disease on physical examination
- Indicated when the diagnosis is in question and distinguishes causes of thyrotoxicosis having elevated or normal uptake over the thyroid gland from those with near-absent uptake
- Elevated in patients with Graves' disease and the pattern is diffuse
Imaging
Thyroid radionuclide scan
- A demonstration of a diffuse goiter may suggest Graves' disease
- May be indicated to distinguish Graves' hyperthyroidism from thyrotoxicosis
- May be used to assess patients with hyperthyroidism and coexisting multinodular goiter before radioactive iodine (RAI) therapy
- Convenient, noninvasive, rapid and accurate diagnostic tool for initial work-up of patients with Graves' disease
- Aids in determining the underlying cause of thyrotoxicosis and detecting concomitant thyroid nodules
- Graves' disease is often characterized by diffuse thyroid enlargement with hypoechogenecity
- May be a diagnostic option for pregnant or lactating women, where radioactive Iodine is contraindicated