Graves' disease

Last reviewed: 1 Nov 2022
Last updated: 25 Nov 2022

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • heat intolerance
  • sweating
  • weight loss
  • palpitations
  • tremor
  • diffuse goitre
  • orbitopathy
More key diagnostic factors

Other diagnostic factors

  • irritability
  • cardiac flow murmur
  • moist, velvety skin
  • scalp hair loss
  • muscle weakness
  • thyroid bruit
  • onycholysis
  • vitiligo
  • pretibial myxoedema
  • acropachy
  • menstrual irregularity
  • sexual dysfunction
Other diagnostic factors

Risk factors

  • family history autoimmune thyroid disease
  • female sex
  • tobacco use
  • high iodine intake
  • lithium therapy
  • biological agent and cytokine therapies
  • radiation
  • radioiodine therapy for benign nodular goitre
  • stress
More risk factors

Diagnostic investigations

1st investigations to order

  • TSH
  • TSH receptor antibodies (TRAb)
  • serum free or total T4
  • serum free or total T3
More 1st investigations to order

Investigations to consider

  • calculation of total T3/T4 or FT3/FT4 ratio
  • radioactive iodine (I-131 or I-123) or technetium-99 (Tc-99) uptake
  • thyroid isotope scan
  • thyroid peroxidase antibodies (TPOAb)
  • thyroid ultrasound
  • CT or MRI scan of orbit
  • skin biopsy
More investigations to consider

Treatment algorithm

ACUTE

thyroid storm

ONGOING

subclinical Graves' disease

symptomatic non-pregnant, non-lactating adults

pregnant women

children

Contributors

Authors

Salman Razvi, MD

Consultant Endocrinologist and Senior Lecturer

Translational and Clinical Research Institute, Queen Elizabeth Hospital, Gateshead

Newcastle University

Newcastle upon Tyne

UK

Disclosures

SR declares that he has no competing interests.

Acknowledgements

Dr Salman Razvi would like to gratefully acknowledge Dr Petros Perros, Dr Douglas S. Ross, Dr George Hennemann, and Dr Vahab Fatourechi, previous contributors to this topic.

Disclosures

PP, DSR, GH, and VF are authors of references cited in this topic.

Peer reviewers

Elizabeth N. Pearce, MD

Associate Professor of Medicine

Boston University Medical Center

Boston

MA

Disclosures

ENP is a consultant for Scientific Consulting Company GmbH and a management council member for the Iodine Global Network.

Kristien Boelaert, MD, PhD, FRCP

Reader in Endocrinology

Institute of Metabolism and Systems Research

College of Medical and Dental Sciences

University of Birmingham

Birmingham

UK

Disclosures

KB declares that she has no competing interests.

Paul Carroll, MD, FRCP

Clinical Lead for Endocrinology

Chair of Thyroid MDM

Guy’s and St Thomas’ NHS Trust

London

UK

Disclosures

PC declares that he has no competing interests.

David Cooper, MD

Division Head

Endocrinology

Sinai Hospital of Baltimore

Baltimore

MD

Disclosures

DC declares that he has no competing interests.

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