Graves disease

...................................................................................................................................................................................................

admin | Nov 20, 2010 | 0 comments
...................................................................................................................................................................................................

Gravesdisease is the most common cause of hyperthyroidism due to circulationg Thyroid-stimulating immunoglobulins (TSIs) .Gravesdisease is named after Robert.J. Graves in 1830.

What is the pathophysiology of Graves disease?

Graves disease is due to autoantibody called thyroid receptor antibody(TRAb) which cause relese of thyroid hormone and thyroglobulin that is mediated by Cyclic AMP .

In graves disease , anti-sodium-iodide symporter, antithyroglobulin, and antithyroid peroxidase antibodies have little role for causing hyperthyroid state.

What is the sign and symptoms of graves disease?

The symptoms of graves disease are as follows:

Fatigue, general weekess
Heat intolerance ,weight loss despite increase of similar appetite
Anxiety, irritabilty, difficult sleeping
warm, moist ,fine skin, sweating, vitiligo, alopecia
Tremor
back pain ,loss or stamina
Palpitaitons, dyspnea on exertion, chest pain, edema
Incresed bowel motility, hyperdefecation with or without diarrhea
Tearing, gritty sensation in the eye, photophobia, protruding eye, eye pain ,visual loss, diplopia
Polyuria, polydipsia
Easy bruising
Irregular menstrual peroids, Impotence
The sign of graves are as follows:
Warm fine skin ,increase sweating
Pretibial myexdema
Chemosis, conjunctival irritation, widening of the palpebral fissure, proptosis, lid lag, lid retraction.
Thyroid gland diffusely enlarged with thyroid bruits, thyoid nodules may be palpable.
Tachypnea, tachycardia, murmur, irregular heart rate and rhythm
Edema
Hand tremor
Restlessness , anxiety ,depression

What are the differential diagnosis of graves disease?

Drug-induced hyperthyroidism
Radiation-induced thyroiditis
Toxic multinodular goiter
Exogenous thyroid hormone
Postpartum thyroiditis
Silent thyroiditis
Pituitary resistance to thyroid hormone

How to diagnosed graves disease?

Diagnosis relies on patients history ,physical examination , lab tests and radiological imaging .

Laboratory tests shows:

Free T4 levels or the free T4 index is usually elevated, as is the free T3 level or free T3 index.
Detection of TSIs is diagnostic for Graves disease.
Antithyroglobulin antibodies or antithyroidal peroxidase antibodies, are usually present.
Increased sex hormone–binding globulin levels and decreased free testosterone levels.

Radiological imaging shows:

Radioactive iodine uptake is increased and diffusely distrubuted over the entire gland.
In some patients USG , CT and MRI helps to diagnosed graves diseas.

How to managed Graves disease?

There is no treatment to stop the immune symstem from producing the antibodies that cause the graves disease.Treatment involves alleviation of symptoms and correction of the thyrotoxic state.
Antithyroid drugs: These drugs is used to decrease the thyroid hormone level , including propylthiouracil and methimazole.
Radioactive iodine: This is the most commonly used treatment for graves disease .Thyroid function test results generally improve within 6-8 weeks of therapy.
Beta blockes: These drugs used to prevent rapid heart rate, nervousness and tremors , including propranolol ,atenolol ,metoprolol and nadolol .
Surgery: Sugery is indicated with patients who are noncompliant with or can not tolerate drugs, large goiters, cannot undergo radioiodine therapy, thyroid nodule that is suggestive of carcinoma, pregnant patients.

References: