II. Epidemiology
- Most common cause of Thyrotoxicosis in the United States (up to 60-80% of cases)
- Prevalence: 20 to 50 in 100,000
- Gender: More common in women
III. Pathophysiology
- Autoimmune disorder
- Thyroid stimulating antibodies bind TSH receptors, resulting in Thyroid Hormone synthesis and release
- Associated with Thyroid Gland hyperplasia and Goiter
IV. Risk Factors
- Female gender
- Autoimmune Disorder
- Family History of Graves Disease (or other autoimmune disorder)
- Tobacco Abuse
- Iodine exposure
V. Findings
- See Hyperthyroidism
- Older patients may present less specifically (e.g. Fatigue, weight loss, Atrial Fibrillation)
VI. 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, 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, 1.5% of cases)
VII. Differential Diagnosis
- See Hyperthyroidism
VIII. Labs
- See Hyperthyroidism
-
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
IX. Imaging
-
Thyroid uptake and scan (first-line study)
- Diffusely high Radioactive Iodine uptake
- Thyroid Ultrasound with doppler (if performed)
- Thyroid hypervascularity with increased flow
X. Management
- See Hyperthyroidism Management
- Referral to ophthalmology for ocular involvement