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{{Graves' disease}}
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==Overview==
==Overview==
 
Some of the physical examination findings in Graves' disease include tachycardia, stare, eyelid lag, proptosis, goiter, resting tremor, hyperreflexia, and a warm, moist, and smooth skin.
== Physical Examination ==
== Physical Examination ==
*Signs include tachycardia, stare, eyelid lag, proptosis, goiter, resting tremor, hyperreflexia, and warm, moist, and smooth skin. <ref>{{Cite journal
| author = [[Terry J. Smith]] & [[Laszlo Hegedus]]
| title = Graves' Disease
| journal = [[The New England journal of medicine]]
| volume = 375
| issue = 16
| pages = 1552–1565
| year = 2016
| month = October
| doi = 10.1056/NEJMra1510030
| pmid = 27797318
}}</ref>


[[Image:pretibial myxedema (Grave's Disease).jpg|thumb|200px|right|Pretibial myxedema (Grave's Disease)]]
*Rare findings (in <1% of patients) include localized dermopathy (i.e., pretibial myxedema) and thyroid acropachy (i.e., clubbing).
Graves' disease may present clinically with one of the following characteristic signs:
*[[Goitre|Goiter]] (an enlarged thyroid gland, sometimes detectable as a swelling in the neck) and [[exophthalmos]] (protuberance of one or both eyes) may be seen on physical examination.
*[[Goitre|goiter]] (an enlarged thyroid gland, sometimes detectable as a swelling in the neck)
*[[exophthalmos]] (protuberance of one or both eyes)
*a non-pitting [[edema]] with thickening of the skin, described as "peau d'orange" or "orange peel", usually found on the lower extremities
*fatigue, weight loss with increased appetite, and other symptoms of [[hyperthyroidism]]


The two signs that are truly ''diagnostic'' of Graves' disease (i.e. not seen in other hyperthyroid conditions) are exophthalmos and nonpitting edema. Goiter, which is caused by an enlarged thyroid gland, can be present with other forms of hyperthyroidism, although Graves' disease is the most common cause. A large goiter is visible to the naked eye, but a smaller goiter may not be clinically detectable, though [[X-ray]]s or [[ultrasound]] can assist in detecting it.


Another sign of Graves' disease is [[hyperthyroidism]], i.e. over-production of the [[thyroid hormone|thyroid hormones]] T3 and T4. Although, [[hypothyroidism]] has also been associated and may be the causating factor in some patients. Hyperthyroidism can be confirmed by measuring elevated blood levels levels of free (unbound) T3 and T4. Other useful laboratory measurements include [[thyroid-stimulating hormone]] (TSH, low in Graves' disease due to negative feedback from the elevated T3 and T4), and protein-bound [[iodine]] (elevated). Thyroid-stimulating antibodies may also be detected [[serology|serologically]].
<gallery>


Definitive diagnosis requires a [[biopsy]].


===Other Graves' Disease Symptoms===
pretibial myxedema (Grave's Disease).jpg|Pretibial myxedema (Grave's Disease)
Some of the most typical symptoms of Graves' Disease are the following:


* [[Palpitations]]
417px-Myxedema.jpg|Pretibial myxedema and acropachy of hyperthyroidism
* [[Tachycardia]] (rapid heart rate: 100-120 beats per minute, or higher)
</gallery>
* [[Arrhythmia]] (irregular heart beat)
* Raised blood pressure ([[Hypertension]])
* [[Tremor]] (usually fine shaking eg. hands)
* [[Excessive sweating]]
* Heat intolerance
* Increased appetite
* Unexplained [[weight loss]] despite increased appetite
* [[Shortness of breath]]
* Muscle [[weakness]] (especially in the large muscles of the arms and legs) and degeneration
* Diminished/Changed sex drive
* [[Insomnia]] (inability to get enough sleep)
* Increased energy
* [[Fatigue]]
* Mental impairment, memory lapses, diminished attention span
* Decreased concentration
* Nervousness, agitation
* Irritability
* Restlessness
* Erratic behavior
* Emotional lability
* Brittle nails
* Abnormal [[breast enlargement]] (men)
* [[Goiter]] (enlarged thyroid gland)
* [[Protruding eyeballs]] (Graves' disease only)
* [[Double vision]]
* Eye pain, irritation, or the feeling of grit or sand in the eyes
* Swelling or redness of eyes or eyelids/eyelid retraction
* Sensitivity to light
* Decrease in menstrual periods ([[oligomenorrhea]]), Irregular and scant menstrual flow ([[Amenorrhea]])
* Difficulty conceiving/infertility/recurrent miscarriage
* [[Hair loss]]
* Itchy skin, hives
* Chronic sinus infections
* Lumpy, reddish skin of the lower legs ([[pretibial myxedema]])
* Smooth, velvety skin
* Increased bowel movements or [[Diarrhea]]


==References==
==References==
{{reflist|2}}
{{reflist|2}}
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[[Category:Endocrinology]]
[[Category:Medicine]]

Latest revision as of 21:56, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1],Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]

Overview

Some of the physical examination findings in Graves' disease include tachycardia, stare, eyelid lag, proptosis, goiter, resting tremor, hyperreflexia, and a warm, moist, and smooth skin.

Physical Examination

  • Signs include tachycardia, stare, eyelid lag, proptosis, goiter, resting tremor, hyperreflexia, and warm, moist, and smooth skin. [1]
  • Rare findings (in <1% of patients) include localized dermopathy (i.e., pretibial myxedema) and thyroid acropachy (i.e., clubbing).
  • Goiter (an enlarged thyroid gland, sometimes detectable as a swelling in the neck) and exophthalmos (protuberance of one or both eyes) may be seen on physical examination.


  • Pretibial myxedema (Grave's Disease)

    Pretibial myxedema (Grave's Disease)

  • Pretibial myxedema and acropachy of hyperthyroidism

    Pretibial myxedema and acropachy of hyperthyroidism

References

  1. ↑ Terry J. Smith & Laszlo Hegedus (2016). "Graves' Disease". The New England journal of medicine. 375 (16): 1552–1565. doi:10.1056/NEJMra1510030. PMID 27797318. Unknown parameter |month= ignored (help)

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