Grave's Disease

Aka: Grave's Disease, Basedows Disease, Exophthalmic Goiter, Graves Disease, Graves Dermopathy

1. See Also
   1. Thyroid Eye Disease
   2. Hyperthyroidism
2. Epidemiology
   1. Most common cause of Thyrotoxicosis in the United States (up to 60-80% of cases)
3. Pathophysiology
   1. Autoimmune disorder
   2. Thyroid stimulating antibodies bind TSH receptors, resulting in Thyroid Hormone synthesis and release
4. Risk Factors
   1. Female gender
   2. Autoimmune Disorder (or Family History of autoimmune disorder)
5. Signs: Specific to Grave's Disease
   1. See Hyperthyroidism
   2. Diffuse, smooth Goiter
      1. Palpated thrill or audible bruit over Thyroid
   3. Infiltrative ophthalmopathy or orbitopathy (Thyroid Eye Disease)
      1. Ophthalmoplegia
      2. Proptosis (Exophthalmos) in 25-50% of cases
      3. Periorbital swelling
   4. Dermopathy
      1. Pretibial Myxedema (Thyroid dermopathy) occurs in 1.5% of cases
         1. Swelling over the tibia
         2. Peau d' orange skin changes
      2. Thyroid Acropachy (hand soft tissue swelling and Digital Clubbing)
      3. Skin Pigment Changes (patchy Hyperpigmentation or vitilgo)
6. Differential Diagnosis
   1. See Hyperthyroidism
7. Lab
   1. Thyroid Stimulating Immunoglobulin (TSH receptor ab)
      1. Specific to Grave's Disease
      2. Linked with ophthalmopathy
      3. Usually not needed for diagnosis
      4. May be used to monitor effects of treatment
   2. Antithyroid Peroxidase Antibody negative
      1. Contrast with positive in Hashimoto's Thyroiditis
8. Imaging
   1. Thyroid Ultrasound with doppler
      1. Thyroid hypervascularity with increased flow
   2. Thyroid uptake and scan
      1. High uptake on scan
9. Management
   1. See Hyperthyroidism Management
   2. Referral to ophthalmology for ocular involvement
10. References
    1. Kravets (2016) Am Fam Physician 93(5): 363-70 [PubMed]