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General Medicine

Graves Disease

Juan Perez, D.O. Reviewed 04/2024
 


BASICS

DESCRIPTION

Autoimmune disease in which thyroid-stimulating hormone receptor (TSHR) activation by thyrotropin receptor antibodies (TRAb) cause increased thyroid hormone secretion. Most common ca...

DIAGNOSIS

HISTORY

  • Tachycardia, palpitations

  • Tremor, restlessness

  • Hyperactivity, anxiety, emotional lability, insomnia, poor concentration

  • Sweating, heat intolerance

  • Pruritus, skin changes

  • Weight loss with i...

TREATMENT

GENERAL MEASURES

The goal is to correct the hypermetabolic state with the fewest side effects and lowest incidence of posttreatment hypothyroidism. 

MEDICATION

First Line

  • Antithyroid drugs: meth...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

Check TSH and T4 levels every 1 to 2 months for the first 6 months after treatment, then every 3 months for a year, and then every 6 to 12 month...

REFERENCES

1
Ren  Z, Qin  L, Wang  JQ, et al. Comparative efficacy of four treatments in patients with Graves’ disease: a network meta-analysis. Exp Clin Endocrinol Diabetes. &#...

ADDITIONAL READING

Lane L, Wood C, Cheetham T. Graves' disease: moving forwards. Arch Dis Child. 2023;108(4):276–281.  

SEE ALSO

Algorithms: Anxiety; Cardiac Arrhythmias; Weight Loss, Unintentional 

CODES

ICD10

  • E05.00 Thyrotoxicosis w diffuse goiter w/o thyrotoxic crisis

  • E05.01 Thyrotoxicosis w diffuse goiter w thyrotoxic crisis or storm

  • E05.20 Thyrotoxicosis w toxic multinod goiter w/o thyrotoxic c...

CLINICAL PEARLS

  • Graves disease accounts for 60–80% of all cases of hyperthyroidism.

  • Potential morbidities of hyperthyroidism include ophthalmopathy, atrial fibrillation, congestive heart failure (CHF),...

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Figure 9.31. Graves? optic neuropathy. Axial computed tomography shows marked enlargement of the ocular muscles at the orbital apex. The medial walls of the orbit are bowed inward by the enlarged medial recti.

 

Figure 9.31. Graves? optic neuropathy. Axial computed tomography shows marked enlargement of the ocular muscles at the orbital apex. The m...

<bold><italic>Figure 18-9</bold> Thyroid gland in hyperthyroidism. A,</bold> Normal thyroid. <bold>B,</bold> Hyperthyroidism. Note the overgrowth (hyperplasia) of follicular epithelium.

 

<bold><italic>Figure 18-9</bold> Thyroid gland in hyperthyroidism. A,</bold> Normal thyroid. <bold>B,</bol...

<bold>FIGURE 21-13. Graves disease.</bold> A young woman with hyperthyroidism displays a mass in the neck and exophthalmos.

 

<bold>FIGURE 21-13. Graves disease.</bold> A young woman with hyperthyroidism displays a mass in the neck and exophthalmos.

 
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