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.
Grave's disease

Grave’s disease Causes and Treatment

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 Ty 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.



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