Grave Disease

GRAVE DISEASE


GRAVE’S DISEASE

  • Also called as diffuse toxic goiter or primary thyrotoxicosis.
  • Grave’s disease is an autoimmune disorder in which antibodies produced by immune system to produce excess of thyroid hormone with enlargement of thyroid gland.
  • Most common cause of thyrotoxicosis.

 

PATHOLOGY-

  • Production of thyroid stimulating antibodies → diffuse hypertrophy and hyperplasia of thyroid gland
  • Gland is soft or firm in consistency and is vascular.
  • Associated with HLA- B8 and HLA- DR3

ETIOLOGY-

  • Autoimmune disorder
  • Familial
  • Thyroid stimulating immunoglobulins
  • Exopthalmoses producing substances
  • Female sex
  • Stress, smoking 

CLINICAL FEATURES-

  • Seen in younger females (20-40 years)
  • Thyroid acropatchy- finger clubbing, opthalmopathy, pretibial myxoedema.

  • Painless palpable goiter with a Bruit
  • CNS- Tremors, hyperkinectic movements
  • CVS- Pulse rate high, tachycardia, palpitation

Opthalmic features-

  • Inferior rectus > medial rectus > superior rectus > Lateral rectus > obliques (Muscle involvement)
  • Thyrotoxic exopthalmos
  • Dalrymple sign (upper eyelid retraction)- most common
  • Lid lag (von graefe sign)
  • Kocher sign (staring appearance)
  • Periorbital edema
  • Proptosis, diplopia
  • Moebiu’s sign – loss of convergence of eyeball (thyrotoxic opthalmoplegia)
  • Stellwag’s sign-  infrequent blinking
  • Joffroy’s sign- absence of wrinkling of forehead
  • Enroth sign- edema of eyelids and conjunctiva
  • Gifflord’s sign
  • Malignant exopthalmos
  • Grave’s dermopathy

INVESTIGATIONS

  • TSH ↓
  • T3, T4 ↑
  • TSAb ↑
  • Sleeping pulse rate ↑
  • Antibody mediated cellular dysfunction-  Type II

    Upregulation  → Graves disease

    Down regulation → Myasthenia gravis

TREATMENT-

  • Antithyroid drugs- Carbimazole/ methimazole/ propylthiouracil (safe in pregnancy)
  • Beta blockers
  • Radioactive iodine – 131I (concentration in thyroid damages it)
  • Surgery- Total thyroidectomy in younger patients

Exam Important

  • Also called as diffuse toxic goiter or primary thyrotoxicosis.
  • Grave’s disease is an autoimmune disorder in which antibodies produced by immune system to produce excess of thyroid hormone with enlargement of thyroid gland.
  • Most common cause of thyrotoxicosis.
  • More common in females.

CLINICAL FEATURES-

  • Seen in younger females (20-40 years)
  • Thyroid acropatchy- finger clubbing, opthalmopathy, pretibial myxoedema
  • Painless palpable goiter with a Bruit
  • CNS- Tremors, hyperkinectic movements
  • CVS- Pulse rate high, tachycardia, palpitation

Opthalmic features-

  • Inferior rectus > medial rectus > superior rectus > Lateral rectus > obliques (Muscle involvement)
  • Thyrotoxic exopthalmos

Dalrymple sign (upper eyelid retraction)- most common

Lid lag (von graefe sign)

Kocher sign (staring appearance)

Periorbital edema

Proptosis, diplopia

Moebiu’s sign – loss of convergence of eyeball (thyrotoxic opthalmoplegia)

Stellwag’s sign-  infrequent blinking

Joffroy’s sign- absence of wrinkling of forehead

Enroth sign- edema of eyelids and conjunctiva

Gifflord’s sign

INVESTIGATIONS

  • TSH ↓
  • T3, T4 ↑
  • TSAb ↑
  • Sleeping pulse rate ↑
  • Antibody mediated cellular dysfunction-  Type II

    Upregulation  → Graves disease

    Down regulation → Myasthenia gravis

TREATMENT-

  • Antithyroid drugs- Carbimazole/ methimazole/ propylthiouracil (safe in pregnancy)
  • Beta blockers
  • Radioactive iodine – 131I (concentration in thyroid damages it)
  • Surgery- Total thyroidectomy in younger patients
Don’t Forget to Solve all the previous Year Question asked on GRAVE DISEASE

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