Grave’s disease

Grave’s disease is thyrotoxicosis, common in females, associated with high iodine intake, occurring between 20 – 50 years of age.

Grave’s ophthalmopathy

• Besides the signs of thyrotoxicosis, there is Grave’s ophthalmopathy.
• decreased extraocular muscle mobility, and corneal injury, periorbital edema, periorbital and conjunctival inflammation,
• Ophthalmopathy associated with hyperthyroidism with the clinical characteristics of exophthalmos,
• There are usually bilateral eye signs with sensation of grittiness, eye discomfort, excess tears, proptosis (sclera is visible between the lower border of iris and lower eye lid).
• There may be corneal exposure and damage.
• There is periorbital edema, red sclera and chemosis with diplopia.
• There may be compression of optic nerve leading to papilledema, peripheral field defects, loss of vision.

Treatment of Ophthalmopathy

• No treatment may be required
• Just underlying hyperthyroidism must be treated
• Antithyroid drugs
• Stop smoking
• Artificial tears – 1% methyl cellulose Dark glasses
• Upright sleeping position and diuretics for periorbital edema
• Prednisone 40 – 80 mg daily + cyclosporine Orbital decompression.
• There may be thyroid dermopathy which is skin changes, thickening, and nodules.
• If   severe and progressive, surgical decompression of the orbit will be required to treat
• There may be thyroid acropatchy which is like club­bing of fingers.

Lab diagnosis

• TSH level is suppressed and free thyroid T_y T₄ are increased.
• There may be microcytic anaemia and thrombocy­topenia.

Grave’s disease Treatment

• Antithyroid drugs Radioiodine
• Subtotal thyroidectomy – to reduce the amount of thyroid tissue.
• rapid amelioration of symptoms with a beta-blocker and measures aimed at decreasing thyroid hormone synthesis: the administration of a thionamide, radioiodine ablation, or surgery
• Antithyroid drugs
• Thionamides – Propyl-thiouracil, carbimazole, Methi­mazole.
• Carbimazole is given 10-20 mg 8 hrly. Propylthiouracil is given 100 mg 8 hrly.
• The doses are reduced when the patient improves. Thyroid function is evaluated 1 month after starting treatment and doses adjusted after 2 months by estimation of T₄ levels.
• The side effects of drugs are rashes, urticaria, fever, arthralgia, hepatitis, SLE like syndrome, agranulocy­tosis.
• Beta blockers ameliorate the symptoms of hyperthyroidism that are caused by increased beta-adrenergic tone
• Propranolol 40 mg 8 hrly may be given to control symptoms.
• For atri’3l fibrillation, Warfarin and Digoxin are used.