Tuesday, 26 October 2010

MRCP revision battle 35.1: Graves' disease

Today is going to be a bit of a thyroid binge with a little gap to end on...

MRCP revision battle 35.1: Graves' disease
MRCP revision battle 35.2: Subacute (de Quervain's) thyroiditis
MRCP revision battle 35.3: Hashimoto's thyroiditis
MRCP revision battle 35.4: Drugs causing hypothyoidism
MRCP revision battle 35.5: Thyroid storm
MRCP revision battle 35.6: Anion gap

MRCP revision battle 35.1: Graves' disease

Graves' disease is an autoimmune condition which causes hyperthyroidism.  Autoantibodies against the thyroid gland are present.  This may be antithyroid peroxidase antibodies or antithyroglobulin antibodies (neither are specific as they may also found in Hashimotos)  or TSH receptor antibody (specific)

Features of Graves' disease include:
  • eye disease (see revision battle 29.2 to recap which features are Graves' disease specific)
  • pretibial myxoedema - only found in Graves
  • thyroid acropachy = clubbing, painful toe and finger swelling - also only in Graves
  • diffuse thyroid enlargement

Associated with Graves' disease include:
  • diabetes 
  • vitiligo
  • Addisons

Treatment options for Graves are:
  1. titrate antithyroid drugs
    • start at 40mg carbimazole
    • continue for 12-18 months
    • less side effects
  2. block and replace
    • start at 40mg carbimazole, levothyroxine once euthyroid
    • treat for 6 to 9 months
    • more side effects
  3. radioiodine

on to battle 35.2...