Graves’ Disease

source: Family Practice Notebook

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
    a. Swelling over the tibia
    b. Peau d’ orange skin changes
  – Thyroid Acropachy (hand soft tissue swelling and Digital Clubbing)
  – Skin Pigment Changes (patchy Hyperpigmentation or vitilgo)