Grave'S Disease: Farida Ulfa 1510211057

GRAVE’S DISEASE
Farida Ulfa
1510211057
Definition Epidemiology
• the most common form of • Females are involved about five times
thyrotoxicosis. more commonly than males.
• The disease may occur at any age,
with a peak incidence in the 20- to 40-
year age group
Etiology
• Graves’ disease is currently viewed as an autoimmune disease of unknown cause.
• There is a strong familial predisposition in that about 15% of patients with Graves’
disease have a close relative with the same disorder,
• and about 50% of relatives of patients with Graves’ disease have circulating thyroid
autoantibodies.
• There is a much higher concordance of Graves’ disease in monozygotic twins
compared to dizygotic twins.
• Proposed environmental triggers include stress, tobacco use, infection, and iodine
exposure.
• The postpartum state, which may be associated with heightened immune function, also
may trigger the development of Graves’ disease in genetically susceptible women.
Sign and symptoms
• In younger individuals, common manifestations include palpitations, nervousness, easy
fatigability, hyperkinesia, diarrhea, excessive sweating, intolerance to heat, and
preference for cold. There is often marked weight loss without loss of appetite.
• Thyroid enlargement, thyrotoxic eye signs , and mild tachycardia commonly occur.
Muscle weakness and loss of muscle mass may be so severe that the patient cannot
rise from a chair without assistance.
• In children, rapid growth with accelerated bone maturation occurs.
• In patients over age 60, cardiovascular and myopathic manifestations predominate;
• the most common presenting complaints are palpitations, dyspnea on exertion, tremor,
nervousness, and weight loss.
Treatment
• 1.Antithyroid medications:
• generally are administered before RAI ablation or surgery.
• Drugs: Propylthiouracil(PTU) have less side effect than Methimazole
the proper dose of drugs depend on TSH & T4 levels.
2.Radioactive iodine therapy:
This method most often used in:
Older patient with small or moderate sized goiter. *
Patient with relapse after medical or surgical therapy. *
Those in whom 2 other method are contraindicated. *
Absolute contraindication: pregnancy
3.Surgical treatment
Patients with coexistent thyroid cancer,those who refuse RAI therapy or have severe
ophtalmopathy or have life threatening reaction to antithyroid medication should undergo
surgery.
ophthalmopathy
• keeping the patient’s head elevated at night and the administration of diuretics may
help diminish periorbital edema. prednisone begun immediately after radioiodine in a
dose of 40 mg/d, tapering the dose 10 mg every 2 weeks, protects against
exacerbation of ophthalmopath.
Anti Thyroid Drugs (ATD)
Imp. considerations Methimazole Propylthiouracil
Efficacy Very potent Potent
Duration of action Long acting BID/OD Short acting QID/TID
In pregnancy Contraindicated Safely can be given
Mechanism of action Iodination, Coupling Iodination, Coupling
Conversion of T4 to T3 No action Inhibits conversion
Adverse reactions Rashes, Neutropenia Rashes, ↑Neutropenia
Dosage 20 to 40 mg/ OD PO 100 to 150mg qid PO
Anti thyroid drugs
• The drug is given for 1–2 years and then it is tapered or discontinued to see whether the
patient has achieved a remission.
• Remissions, defined as normal thyroid function for 1 year following discontinuation of
the antithyroid drug, occur in 20–50% of patients but may not be lifelong.
• Antithyroid drug therapy is generally started with larger doses. When the patient
becomes biochemically euthyroid after 4–12 weeks, maintenance therapy may be
achieved with a lower dose.
• A common regimen consists of giving PTU, 100 mg every 8 hours initially, and then in 4–8
weeks, reducing the dose to 50–200 mg once or twice daily. Methimazole has a longer
duration of action and is preferred by many clinicians,
Complication
• Thyrotoxic crisis (“thyroid storm”) is the acute exacerbation of all of the symptoms and
signs of thyrotoxicosis, often presenting as a syndrome that may be of life-threatening
severity. Laboratory findings include elevated serum T4, FT4, and T3 as well as a
suppressed TSH

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GRAVE’S DISEASE

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