Thyroid
Grave's Disease
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Grave's Disease
, Basedows Disease, Exophthalmic Goiter, Graves Disease, Graves Dermopathy
See Also
Thyroid Eye Disease
Hyperthyroidism
Epidemiology
Most common cause of
Thyrotoxicosis
in the United States (up to 60-80% of cases)
Pathophysiology
Autoimmune disorder
Thyroid
stimulating antibodies bind TSH receptors, resulting in
Thyroid Hormone
synthesis and release
Risk Factors
Female gender
Autoimmune Disorder (or
Family History
of autoimmune disorder)
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)
Differential Diagnosis
See
Hyperthyroidism
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
Imaging
Thyroid
Ultrasound
with doppler
Thyroid
hypervascularity with increased flow
Thyroid
uptake and scan
High uptake on scan
Management
See
Hyperthyroidism Management
Referral to ophthalmology for ocular involvement
References
Kravets (2016) Am Fam Physician 93(5): 363-70 [PubMed]
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