Graves Disease

Incidence: Approximately 5:10,000; prevalence: 1.12%, with 1.3 million pts in USA.

Female-to-male ratio: 7:1; more common in women age 30–60 y.

Family history indicating genetic factor(s) can be involved.

“Thyroid storm” due to surge of plasma thyroid hormones

Airway compromise due to hematoma compressing airway or nerve injury

Hypocalcemia

Cardiovascular complications: dysrhythmia, hemodynamic alterations

Signs of airway obstruction, nerve injury

Signs of metabolism and electrolyte abnormalities

Dysrhythmias

Most common cause of hyperthyroidism.

Clinical manifestations are generally nonspecific initially: Fatigue, weight loss, muscle weakness, heat intolerance, diarrhea, nervousness, diffuse glandular enlargement in neck, anemia, and thrombocytopenia.

Extrathyroid involvement includes ophthalmopathy (25%), dermopathy (1%), and clubbing (0.1%).

Dx involves normal/low TSH with high T ₃ , T ₄ positive TSH-receptor antibody, RAI uptake, and ultrasound with Doppler.

Life-threatening “thyroid storm” can be induced by stress or illness. Symptoms include tachycardia, dysrhythmias, MI, worsened CHF, hyperthermia, anxiety, agitation, confusion, hyperpyrexia, and anorexia. Rx includes fluids, propranolol (1–5 mg IV), hydrocortisone (replacing the exhausted adrenocortical hormone), potassium iodide (KI 60 mg or NaI 1–2.5 g), and PTU (initiate therapy as soon as possible).