Most common cause of hyperthyroidism in countries with sufficient iodine intake.
Caused by TSH receptor antibodies.
Extrathyroidal manifestations include orbitopathy, pretibial myxedema (thyroid dermopathy), or acropachy, which do not occur with other causes of hyperthyroidism.
Diagnostic tests are suppressed serum TSH, elevated levels of circulating thyroid hormones, detectable TSH receptor antibodies, and high thyroid uptake of radioactive iodine (or technetium 99).
Treatment options are antithyroid drugs, radioactive iodine therapy, and thyroid surgery.
Untreated hyperthyroidism, particularly in older people, may result in cardiac arrhythmias, high-output cardiac failure, bone mineral loss, and rarely thyroid storm.
Unusual complications include vision loss secondary to orbitopathy or elephantiasis secondary to dermopathy.
Graves disease is an autoimmune thyroid condition associated with hyperthyroidism. Associated orbitopathy occurs in around 25% of cases and is usually mild; associated dermopathy and acropachy are rare, and almost always seen with orbitopathy. TSH (thyroid-stimulating hormone) receptor antibodies cause the hyperthyroid syndrome. The etiology of extrathyroidal manifestations is less clear. Diagnosis is mostly clinical and is usually confirmed by laboratory evidence of thyroid dysfunction, most commonly hyperthyroidism.
History and exam
Salman Razvi, MD
Consultant Endocrinologist and Honorary Senior Lecturer
Institute of Genetic Medicine and Queen Elizabeth Hospital, Gateshead
Newcastle upon Tyne
SR has received speaker fees from Merck plc and Abbott India Pharmaceuticals Ltd, the makers of levothyroxine.
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.
PP, DSR, GH, and VF are authors of references cited in this topic.
Elizabeth N. Pearce, MD
Associate Professor of Medicine
Boston University Medical Center
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
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
PC declares that he has no competing interests.
David Cooper, MD
Sinai Hospital of Baltimore
DC declares that he has no competing interests.
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