Graves disease is the most common form of hyperthyroidism and is caused by stimulating antibodies against the TSH receptor. Presenting symptoms include weight loss, fatigue, increased sweating, palpitations, diarrhea, irritability, and insomnia. Physical examination discloses diffuse goiter, fine tremor, tachycardia, thyroid ophthalmopathy in approximately 20% of patients (eg, exophthalmos, lid lag, lid retraction, and conjunctival injection), and less frequently infiltrative dermopathy (pretibial myxedema).
Diagnosis is made based on clinical features and elevated serum free thyroid hormones (fT4 and fT3), suppressed serum TSH, and positive serum TSH receptor antibodies. Treatment includes antithyroid drugs (carbimazole/methimazole or propylthiouracil) for a total of 18 months and beta-blockers (eg, propranolol). A definitive treatment is radioactive iodine or total thyroidectomy; these treatments are recommended in patients with recurrent hyperthyroidism or intolerance to antithyroid drugs.
See Hyperthyroidism in The Manuals.
References
Jameson JL, de Groot LJ. Handbook of Endocrinology, Adult and Pediatric, 7th ed., Vol 2. Philadelphia, PA: Saunders; 2015:1437-65.
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