Graves Disease vs Hyperthyroidism

Grave's disease is one of the possible causes of hyperthyroidism. This post is going to be about the signs and symptoms specific to Grave's, as opposed to those that you would observe in hyperthyroidism due to any causes.

Source: http://www.harrisonspractice.com/practice/ub/view/Harrisons%20Practice/141320/1.0/hyperthyroidism__graves%27_disease_



Hyperthryoidism

---

Classic symptoms

• Unintentional weight loss despite increased caloric intake, with ravenous appetite
• Heat intolerance and excessive sweating
• Palpitations
• Hyperactivity
• Anxiety
• Tremulousness
• Fatigue and weakness
• Insomnia
• Irritability, dysphoria
• Impaired concentration
• Increased stool frequency, with occasional diarrhea and mild steatorrhea
• Pruritus
• Oligomenorrhea or amenorrhea
• Erectile dysfunction
• Polyuria

Unusual symptoms

• Weight gain
  • Occurs in 5% due to disproportionate increase in caloric intake that exceeds the elevation in metabolic rate
• Gynecomastia
• Urticaria

Signs

• Thyroid examination
  • Variable findings, depending on the etiology of thyrotoxicosis
    • Diffusely enlarged goiter (2–3 times): Graves’ disease
    • Nodular: toxic multinodular goiter or toxic adenoma
• Cardiovascular
  • Sinus tachycardia
  • Bounding pulse/widened pulse pressure
  • Aortic systolic murmur
  • Atrial fibrillation, more common in patients > 50 years of age
• Neurologic/musculoskeletal
  • Hyperreflexia
  • Muscle wasting
  • Proximal myopathy without fasciculation
  • Tremor
  • Rarely: chorea, hypokalemic periodic paralysis (See Associated Conditions.)
• Dermatologic
  • Warm, moist skin
  • Palmar erythema
  • Onycholysis
  • Fine hair texture
    • Diffuse alopecia (up to 40% of patients)
• Ophthalmologic
  • Lid retraction or lag
  • Stare
  • Rarified blinking

Apathetic hyperthyroidism

• A presentation of Graves’ disease often observed in elderly persons
• Characterized by a paucity of classic symptoms of thyrotoxicosis
• Fatigue and weight loss are the predominant symptoms.
• Often accompanied by atrial fibrillation, which may be sole clinical manifestation
• May be mistaken for depression

 Grave's Disease

---

Graves’ ophthalmopathy (or orbitopathy)

Also called thyroid-associated ophthalmopathy, as it occurs in the absence of Graves’ disease (such as in autoimmune hypothyroidism) in 10% of patients

Symptoms

• Earliest symptoms include sensation of grittiness, eye discomfort, and excessive tearing.
• Later symptom: diplopia (in 5–10% of patients, due to eye muscle dysfunction, swelling, and fibrosis)

Signs

• Proptosis in about one-third of patients (often asymmetrical)
• Periorbital edema
• Conjunctival injection
• Chemosis
• Papilledema due to optic nerve compression
• Peripheral field defects due to optic nerve compression
• If optic nerve compression is left untreated, it can lead to permanent loss of vision.
• Unilateral in up to 10%

NO SPECS: acronym of eye changes

• 0 = No signs or symptoms
• 1 = Only signs (lid retraction or lag), no symptoms
• 2 = Soft-tissue involvement (periorbital edema)
• 3 = Proptosis (>22 mm)
• 4 = Extraocular muscle involvement (diplopia)
• 5 = Corneal involvement
• 6 = Sight loss
• Patients do not necessarily progress from one class to another.

Thyromegaly

• Degree of thyroid enlargement varies from minimal to substantial.
• Enlargement is bilateral and usually symmetric.
• Consistency is moderately firm, with increased turgor.
• May be accompanied by a thrill or bruit in more severe cases, due to the increased vascularity of the gland and the hyperdynamic circulation

Thyroid dermopathy (< 5%)

• Noninflamed, indurated plaque with a deep pink or purple color; may have an "orange-skin" appearance
• Most frequently observed over anterior and lateral aspects of the lower leg (pretibial myxedema), but may occur at other sites, particularly after trauma
• Nodular involvement can occur, and the condition can rarely extend over the whole lower leg and foot, mimicking elephantiasis.
• Almost always accompanied by moderate or severe ophthalmopathy
• May improve spontaneously

Thyroid acropachy (< 1%)

• Form of clubbing
• Strongly associated with presence of thyroid dermopathy

**See the disclaimer**