A young woman presented with weight loss, hand tremor and heat intolerance for 2 months. On examination, she was found to have a diffuse goiter with thyroid bruit and features of Graves’ ophthalmopathy.
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- Goitre
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- Graves’ ophthalmopathy
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- Neck collar scar
Other important signs in Graves’ disease
- Lid lag, lid retraction, chemosis, ophthalmoplegia
- Pre-tibial myxoedema (bilateral pinkish, brown dermal plaques)
- Sinus tachycardia, irregular pulse suggestive of atrial fibrillation
- Signs of heart failure
Important investigations
- Thyroid function test to look for suppressed TSH with raised free T4 level in overt hyperthyroidism
- Measurement of thyroid autoantibodies including anti thyroglobulin, anti microsomal antibodies +/- anti TSH receptor antibody
- +/- Thyroid scan showing diffusely increased uptake in Graves’ disease
- +/- USG thyroid showing diffuse enlargement with homogenous echogenicity
Management
- Anti-thyroid drugs with thioureas (carbimazole or propylthiouracil)
- Beta-blockers (inderal) if not contraindicated
- +/- Radioactive iodine (commonly considered for relapsed disease)
- +/- Total thyroidectomy (for definitive treatment especially in patients with moderate to severe Graves’ opthalmopathy after stabilization)