Graves Disease

Exam Cram

• Graves is an autoimmune cause of hyperthyroidism

• Presentation: hyperthyroidism in young females, exopthalmos

• Diagnosis: +ve anti TSH receptor antibodies (TRAbs)

• Management: antithyroid medications (e.g. carbimazole)

Outline

Background 

Plasma cells produce anti TSH receptor antibodies (TRAbs)

Assessment

History:

• Lady 20-30 yrs

• Anxiety, sweating, weight loss, diarrhoea

Examination:

• Goitre- smooth, mildly tender

• Fine tremor

• HR- sinus tachycardia

• Granuloma annulare

Investigations

• Hyperthyroidism

  • • TSH < 0.05

    • T3/4 raised

• Anti TSH Receptor antibodies (TRAbs) +ve

• Radio-iodine: increased global uptake

Diagnosis

Any one of these features is diagnostic: 

• Anti TrAb antibdies (anti TSH receptor)

• Exopthalmos

Differentials: subacute thyroiditis

Management

Acute:

Hyperthyroidism

1. Block and replace: high dose carbimazole and thyroxine

2. Propylthiouracil 2nd line to carbimazole

Long term definitive mx:

1. Radio-iodine: 

2. 1. • Those who are not pregnant, can avoid children for 7 days

      • Can take 3m to achieve full effect (block and replace, slowly down titrated)

2. Thyroidectomy: if unable to tolerate radio- iodine

Med Reg Notes

Thyroid eye disease

Management

1. Manage hyperthyroidism as above

2. Prednisolone

3. Toclizumab, Rituxumab

Exacerbated by

1. Cigarette smoking

2. Radio-iodine

Pregnancy

• Carbimazole safe in pregnancy

• Propylthiouracil: risk of maternal hepatic toxicity

References and Resources

Page written in 2024.