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Graves' disease (Aetiology & Risk Factors (Autoimmune disease…
Graves' disease
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Treatment
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Surgery - indicated in those with large goitre, poor response to drugs and have drug side-effects
Pathophysiology
It is an autoimmune disease mediated by antibodies that stimulate the TSH receptor. This leads to excess secretion of thyroid hormones and hyperplasia of thyroid follicular cells
May have a variable affect on thyroid function and patient may remain euthyroid or become hypothyroid
Serum IgG antibodies bind to TSH receptors in the thyroid, stimulating thyroid hormone production. These are specific for Graves' disease
Diagnosis
TFTs
- Serum TSH can exclude primary thyrotoxicosis
- If TSH is suppressed but free T4 levels are normal, then free T3 level is need
Autoantibodies
- Most commonly seen in Graves' disease
- Antimicrosomal antibodies (against thyroid peroxidase), can differentiate from toxic nodular hyperthyroidism
- Antithyroglobulin antibodies
- TSH-receptor antibodies, which are commonly present in Graves' disease
Imaging
- Thyroid ultrasound scan
- Thyroid uptake scans
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Clinical Presentation
General
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Palmar erythema, warm moist skin and fine tremor
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Graves' specific
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Dermopathy
Pretibial myxoedema - raised, purple-red symmetrical skin lesions over the anterolateral aspects of skin
Thyroid acropachy - clubbing, swollen fingers and periosteal bone formation
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