Grave's Disease

Question 1

Description: What does Grave’s Disease involve?

Answer 1

• Swelling of the neck and protrusion of the eyes

Question 2

Pathology: Describe the pathology of Grave’s Disease

Answer 2

• Auto-antibodies stimulate the receptor that responds to thyroid stimulating hormone, resulting in hyperthyroidism

Question 3

Signs: What are the signs of Grave’s disease upon examination? (3)

Answer 3

• Acropachy/ clubbing
• Thyroid eye disease (eye bulging)
• Pre-tibial myxoedema (thickening of the skin on the shins)

Question 4

Treatment: How do we treat a patient with Grave’s Disease? (4)

Answer 4

• Anti-thyroids (carbimazole - reduces production of thyroid hormone)
• Beta blockers (symptom control until antithyroid drug therapy takes effect)
• Radioactive iodine (accumulates in the thyroid and irradiates the gland with its beta and gamma radiations)
• Surgery (thyroidectomy)

Question 5

Extra: What are the indications for thyroidectomy (surgical removal of all parts of the thyroid gland)?

Answer 5

• Airway obstruction
• Malignancy (thyroid cancer)
• Thyrotoxicosis
• Cosmesis
• Retrosternal extension

Question 6

Extra: What are the complications of thyroidectomy?

Answer 6

Complications of thyroidectomy:

• Hypothyroidism
• Hypoparathyroidism
• Bleeding (primary or secondary)
• Infection
• Scar
• Voice hoarseness (due to damage of the recurrent laryngeal nerve)
• Thyroid storm