Treatment Guideline Chart
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.

Graves'%20disease Diagnosis


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
  • 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
Thyrotropin receptor antibodies (TRAbs) measurement
  • 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
 Radioactive Iodine Uptake (RAIU)
  • 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


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
Thyroid ultrasound
  • 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
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