• Diffusely hypersecretory goiter with resultant increased levels of thyroid hormone in the blood
• Nervousness, weight loss with increased appetite, heat intolerance, increased sweating, muscular weakness and fatigue, increased bowel frequency, polyuria, menstrual irregularities, infertility
• Goiter, tachycardia, atrial fibrillation, warm moist skin, thyroid thrill and bruit, cardiac flow murmur, gynecomastia
• Eye signs include:
• Thyroid-stimulating hormone (TSH) low or absent
• Increased radioactive iodine uptake
• Increased tri-iodothyronine (T3) and thyroxine (T4)
• Abnormal T3 suppression test
• Elevated thyroid-stimulating immunoglobulin
• 85% of all hyperthyroid cases
• Peak age of onset is fourth decade
• Incidence: 23 per 100,000
• Female:male ratio of 4:1 to 5:1
• 50% of patients show clinical signs of ophthalmopathy
• 50% of patients have myopathy that presents as proximal muscle weakness
• Nervousness, increased diaphoresis, heat intolerance, tachycardia, palpitations, fatigue, and weight loss
• Nodular, multinodular, or diffuse goiter on physical exam
• Flushed and staring appearance
• Warm, thin, and moist skin
• Fine hair
• Possible exophthalmos
• Pretibial myxedema
• Shortened Achilles reflex time
• Suppressed TSH
• Elevated T3, free T4, and radioactive iodine uptake
• Failure to suppress radioiodine uptake with exogenous T3
• Failure of rise in TSH with thyrotropin-releasing hormone (TRH) administration
• High thyroid-stimulating immunoglobulin level
• Low serum cholesterol
• Occasional hypercalcemia, hypercalciuria, or glycosuria
• Diffuse increased uptake on radioactive iodine scan
• Thyroid US reveals an enlarged gland, with or without nodules, and high vascular flow
• Orbital US, CT, or MRI can evaluate extraocular muscles, retrobulbar soft tissue, and optic nerve
• Clinical manifestations may go through periods of exacerbation and remission
• Graves disease is an autoimmune disease in which antibodies are directed against the TSH receptor
• Pathogenesis of ocular problems in Graves disease is unclear
• Eye complications may begin before and continue after thyroid dysfunction
• Antithyroid drugs, radioactive iodine, or thyroidectomy
• Treatment of ocular problems of Graves disease include:
-Maintenance of euthyroid state
-Protecting the eyes from light and dust
-Elevating the bed
-Methylcellulose or guanethidine eye drops
• Very large goiter or multinodular goiter with relatively low radioactive iodine uptake
• Thyroid nodule that may be malignant
• Patients with ophthalmopathy
• Pregnant patients or children
• Women who wish to become pregnant ...
Log In to View More
If you don't have a subscription, please view our individual subscription options below to find out how you can gain access to this content.
Want remote access to your institution's subscription?
Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.
If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.
AccessSurgery Full Site: One-Year Subscription
Connect to the full suite of AccessSurgery content and resources including more than 160 instructional videos, 16,000+ high-quality images, interactive board review, 20+ textbooks, and more.
Pay Per View: Timed Access to all of AccessSurgery
24 Hour Subscription $34.95
48 Hour Subscription $54.95
Pop-up div Successfully Displayed
This div only appears when the trigger link is hovered over.
Otherwise it is hidden from view.