IPLab:Lab 6:Graves Disease
This 18-year-old girl presented with complaints of swelling in the neck, weight loss, bulging of the eyes, tremor, decreased heat tolerance, loose stools, and occasional palpitations. Physical examination revealed normal blood pressure, resting tachycardia of 110 beats per minute, mild exophthalmos, eyelid lag, and a diffusely enlarged thyroid gland. Pertinent laboratory findings were thyroxine (T4) level 30.8 mcg/dL, free thyroxine was 2.7 ng/dL, and thyroid stimulating hormone (TSH) was 0.22 mcIU/mL. She was given propylthiouracil until she became nearly euthyroid, at which time a thyroidectomy was done.
The thyroid gland weighed 45 grams. It was beefy red in color and had a homogeneous fleshy consistency.
Autoantibodies directed towards the TSH receptor of the thyroid cause stimulation of the thyroid leading to increased secretion of thyroid hormones and growth of the thyroid gland.
- Graves' disease is more common in females than males
- It has been linked to HLA-B8 and DR3 in whites but different haplotypes in Asians
- It has a familial predisposition
- It is more common in patients with other forms of autoimmune thyroid problems (e.g., Hashimoto's thyroiditis)
There is little evidence to suggest an increased frequency of thyroid cancer in patients with Graves' disease.
- eMedicine Medical Library: Pediatric Graves Disease
- eMedicine Medical Library: Hyperthyroidism, Thyroid Storm, and Graves Disease
- eMedicine Medical Library: Goiter
- eMedicine Medical Library: Diffuse Toxic Goiter
- Merck Manual: Overview of Thyroid Function
- Merck Manual: Hyperthyroidism
- Smith TJ and Hegedüs L. Graves’ Disease. NEJM 2016 375:1552-1565.
- Fraser T, Green D. Weathering the storm: beta-blockade and the potential for disaster in severe hyperthyroidism. Emerg Med (Fremantle) 2001 Sep;13(3):376-80.
Related IPLab Cases
A normal T4 level is 4 to 11 mcg/dL.
A normal free T4 level is 0.71 to 1.85 ng/dL.
A normal thyroid gland weighs 25 grams.
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