Medically Fit For Exams
Medically Fit For Exams



Disease group which results in an excess of thyroid hormone, and symptoms relating to increased metabolism, oxygen consumption and protein turnover


Risk factors

  • Graves disease
    • Other autoimmune disorders
    • Family history
    • Female


Differential diagnosis



  • Common in younger age groups



  • Graves disease = autoimmune
    • IgG antibodies mimic TSH, so activate TSH receptors and increase production of T3 and T4
    • May be a result of gram negative infection initially à molecular mimcry
    • These TSHr antibodies are present in 85-90% of patients with Graves disease
  • Idiopathic


Clinical features

  • Tachycardia and palpitations
  • Weight loss
  • Increased appetite
  • Tremor
  • Diarrhoea
  • Oligomenorrhoea/amenorrhoea
  • Decreased libido
  • Goitre
  • Temperature intolerance
  • Irritability/anxiety
  • Osteoporosis
  • Graves only:
    • Exopthalmus
    • Lid lag
    • Gritty eyes
    • Pretibial myxoedema
    • Palmar erythema



  • Increased thyroid hormone circulation as a result of TSH receptor stimulation by IgG antibodies



  • Thyroid function tests
    • Increased T4 and T3
    • Decreased TSH
    • Thyroid antibodies
  • FBC



  • Carbimazole (a thionamide) is first line drug – acts to inhibit throperoxidase (which oxidises iodide ions to enable binding to thyroglobulin to make thyroid hormones)
    • Side effects include bradycardia and severe neutropaenia (patients asked to look out for sore throat/strep)
    • Takes 4-6 weeks to work, standard course is 18 months
    • Block-titration = enough is given to normalise thyroid levels
    • Block-replacement = total block of thyroid hormone production, thyroxine given to normalise levels
  • Propylthiouracil is another thionamide that is used if carbimazole doesn’t work, has more side effects
  • 50% of patients never have reoccurrence after treatment with carbimazole
  • If reoccurance – radioactive iodine or surgery
  • Iodine-131 is radioactive – is taken up into follicular cells and kills them. Contraindicated in pregnancy/trying to become pregnant, those working with young children, incontinent (risk of public radioactive contamination). Carbimazole must be stopped a few days before radioactive therapy to allow iodine to be taken up and work. Radioactivity stops after about 2 months
  • Thyroidectomy (partial or complete) is another option if recurrence after treatment with carbimazole. Levothyroxine to replace thyroid hormones
  • Propranolol used for symptomatic relief – improved tachycardia and palpitations, improves tremor



  • Euthyroid can normally be achieved using variety of treatment methods
  • Does not affect life expectancy
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