Graves' disease

Question 1

Define Graves’ Disease

Answer 1

Autoimmune thyroid condition associated with hyperthyroidism

Question 2

Aetiology of Graves’ Disease

Answer 2

Circulating IgG antibodies bind to activate G-protein-coupled thyrotrophin receptors/TSH receptors -> smooth thyroid enlargement + increased hormone production (esp. T3)
Autoantibodies can also react with orbital antigens

May be triggered by stress, infection and childbirth

Question 3

Risk factors for Graves’ Disease

Answer 3

Autoimmune diseases (T1DM, vitilgo)
Family history of autoimmune disease
Female
Smoking
High iodine intake
Lithium therapy 
Radiation
Stress

Question 4

Epidemiology of Graves’ Disease

Answer 4

Most common form of hyperthyroidism
Highest incidence 40-60
4-9x more common in women

Question 5

Symptoms of Graves’ Disease

Answer 5

Heat intolerance
Diarrhoea
Irritability or mood swings
Sweating
Weight loss (despite increased appetite)
Tremor
Hair loss
Muscle weakness
Menstrual irregularity 
Sexual dysfunction

Question 6

Signs of Graves’ Disease on examination

Answer 6

Tachycardia
Exophthalmos/proptosis 
Ophthalmoplegia 
Diffuse goitre
Tremor
Pretibial myxoedema (oedematous swellign above lateral malleoli)
Acropathy (clubbing + soft tissue swelling)
Palmar erythema

Question 7

Investigations for Graves’ Disease

Answer 7

TFTs: T4+T3 elevated, TSH suppressed, T3/T4 ratio elevated

TSH receptor antibodies: +Ve (95%)
Anti-thyroid peroxidase antibodies (75%)

Thyroid isotope scan: smooth uptake

Thyroid USS: highly vascular, diffuse, enlarged

CT/MRI orbit: muccle thickening

Skin biopsy; thyroid dermopathy