II. Epidemiology
- Most common cause of Thyrotoxicosis in the United States (up to 60-80% of cases)
III. Pathophysiology
- Autoimmune disorder
- Thyroid stimulating antibodies bind TSH receptors, resulting in Thyroid Hormone synthesis and release
IV. Risk Factors
- Female gender
- Autoimmune Disorder (or Family History of autoimmune disorder)
V. Signs: Specific to Grave's Disease
- See Hyperthyroidism
- Diffuse, smooth Goiter
- Palpated thrill or audible bruit over Thyroid
- Infiltrative ophthalmopathy or orbitopathy (Thyroid Eye Disease)
- Ophthalmoplegia
- Proptosis (Exophthalmos) in 25-50% of cases
- Periorbital swelling
- Dermopathy
- Pretibial Myxedema (Thyroid dermopathy) occurs in 1.5% of cases
- Swelling over the tibia
- Peau d' orange skin changes
- Thyroid Acropachy (hand soft tissue swelling and Digital Clubbing)
- Skin Pigment Changes (patchy Hyperpigmentation or vitilgo)
- Pretibial Myxedema (Thyroid dermopathy) occurs in 1.5% of cases
VI. Differential Diagnosis
- See Hyperthyroidism
VII. Lab
-
Thyroid Stimulating Immunoglobulin (TSH receptor ab)
- Specific to Grave's Disease
- Linked with ophthalmopathy
- Usually not needed for diagnosis
- May be used to monitor effects of treatment
-
Antithyroid Peroxidase Antibody negative
- Contrast with positive in Hashimoto's Thyroiditis
VIII. Imaging
- Thyroid Ultrasound with doppler
- Thyroid hypervascularity with increased flow
-
Thyroid uptake and scan
- High uptake on scan
IX. Management
- See Hyperthyroidism Management
- Referral to ophthalmology for ocular involvement