A Presentation on

Grave’s Disease

By Matthew Kirton

What is Grave’s Disease?

It is an autoimmune condition that affects

Thyroid function, causing enlargement and

overactivity (hyperthyroidism) of the Thyroid.

Epidemiology

● 100-200 cases per 100,000 every year, internationally.

● Significantly higher incidence in women, 7:1 ratio.

● Most common amongst young women, but can occur at

any age. Most seen between the ages of 20-40

● No definitive genetic linkage

Signs and Symptoms

● Most distinct signs, bulging eyes

(Exopthalmos), pretibial myxedema and

thyroid acropachy

● Enlargement of the Thyroid (Goitre)

● Increased appetite, coupled with weight loss

● Heat intolerance and diaphoresis

● Hyperactivity and fatigability

Exopthalmoshttp://en.wikipedia.org/wiki/File:Proptosis_and_lid_retraction_from_Graves%27_Disease.jpg

Thyroid Acropachyhttp://upload.wikimedia.org/wikipedia/commons/c/cd/Acopaquia.jpg

Pretibial Myxedemahttp://www.consultant360.com/sites/default/files/images/1202Con_Schein_Fg4.jpg

Class 2 Strumahttp://en.wikipedia.org/wiki/File:Struma_001.jpg

Hyperactivity

Fatigability

● Autoantibodies (TSI, TBII, TGI) target and bind to TSH

Receptors.

● Autoantibodies act like TSH (thyrotropin), causing

excessive release of T3 and T4 into the blood.

● This spike in Thyroid hormone release, causes TSH

levels to decrease (negative feedback)

Pathophysiology

Pathophysiology cont’d

● Exopthalmos is caused by antibodies attacking the eye

muscle fibroblasts, forcing a change into adipose tissue.

● The resulting adipose tissue builds up, exerting a

pressure behind the eyes.

● Pressure build up constricts draining veins, resulting in

edema

Pathophysiology cont’d

● The increases in appetite and weight loss, the heat

intolerance and diaphoresis, are caused by the Thyroid

hormones increasing the Basal Metabolic Rate

● Hyperactivity and Fatigability occurs as Thyroxine

overstimulates the motor end plate of the

neuromuscular junction.

Diagnosis

● A blood test is carried out, checking for increased free

Throxine and Triidothyronine levels in the blood.

● Exopthalmos and non-pitting pretibial myxedema are

unique features for Grave’s Disease when coupled with

hyperthyroidism. Confirmatory.

Prognosis

With treatment, the prognosis is normally very

positive, without any major complications barring

any that may arise from thyroidectomy.

Without treatment there are long term health

problems; excessively dry eyes, blindness,

continued muscle degradation etc.

Treatment

● Antithyroid drugs (methimazole)

● Radioiodine

● Thyroidectomy

References● http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001398/#adam_000358.

disease.symptoms● http://emedicine.medscape.com/article/120619-overview#a0104● http://arbl.cvmbs.colostate.edu/hbooks/pathphys/endocrine/thyroid/physio.

html● http://www.rightdiagnosis.com/g/graves_disease/prognosis.htm● http://www.nlm.nih.gov/medlineplus/ency/article/000358.htm● http://www.hopkinsmedicine.org/endocrine/graves/Answer.asp?

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