In Graves disease, antibodies stimulate the thyroid to make too much thyroid hormone, which speeds up the body's metabolism. It is the most common cause of hyperthyroidism and can also affect the eyes and the skin.
Key symptoms
- Weight loss despite a good appetite
- Palpitations, anxiety and tremor
- Heat intolerance and sweating
- Frequent stools and lighter periods
- Gritty, bulging eyes or double vision
What you find on exam
- Fast heart rate, sometimes atrial fibrillation
- Smooth, diffuse goiter, sometimes with a bruit
- Fine tremor, warm moist skin, brisk reflexes
- Eye signs: lid lag, bulging eyes
- Thickened skin on the shins in some patients
Tests
- TSH low; free T4 or T3 high
- TSH receptor antibodies confirm Graves
- Radioactive iodine uptake if the cause is unclear: high and diffuse in Graves
- ECG if palpitations, to look for atrial fibrillation
Treatment basics
- A beta blocker such as propranolol for symptoms
- Methimazole to block hormone production; propylthiouracil in the first trimester of pregnancy
- Radioactive iodine or surgery for definitive treatment
- Stop smoking; refer to a specialist for eye disease
Red flags
- Fever, agitation and a very fast heart rate: thyroid storm
- Sore throat or fever on methimazole: check the white cell count
- Vision loss or painful eyes
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.