How is graves diagnosed

Early in the course of Graves' Disease, the symptoms may be similar to other conditions and may delay or confuse the diagnosis.

Untreated and undiagnosed Graves' disease may develop the following findings which will be readily appreciated by your skilled endocrinologist:. Thyroid Goiter - Graves' Disease will produce diffuse enlargement of the thyroid gland Called diffuse thyrotoxic goiter. Which may produce symptoms of:. Graves' disease is an autoimmune disease where the body's immune system, for some reason, turns against a part or parts of the body.

Although we know little about why this occurs, we do know that some patient's families clearly can have apparent predispositions to Graves' disease.

As a result of this autoimmune event, patients with Graves' disease produce proteins called thyroid stimulating immunoglobulins. These immunoglobulins have the ability to link to a type of keyhole on the thyroid cells thyroid stimulating hormone TSH receptor just as TSH will do.

In this way, the thyroid stimulating immunoglobulins push the thyroid cells to produce hormone in a continuous and unregulated fashion. In fact, there is no way to turn it off since the thyroid stimulating immunoglobulin production is not controlled in any way.

The thyroid cells basically get tricked into producing more and more thyroid hormone thus producing hyperthyroidism. The following are a list of tests that are required in the evaluation of a patient with a Graves' Disease. Medical history and physical examination is required for all patients with a potential diagnosis of Graves' Disease.

If there is a suspicion that you may have a Graves' Disease, your health care professional will want to know your complete medical history. You will be asked questions about your possible risk factors, symptoms, and any other health problems or concerns.

If someone in your family has had a diagnosis of Graves' disease or other autoimmune disorders, these are important factors. Your doctor will examine you to get more information about possible signs of thyroid goiter and other health problems. During the exam, the doctor will pay special attention to the size and firmness of your thyroid and any enlarged lymph nodes in your neck.

Examination of your voice box is part of the physical examination obtained by the surgeon for any patient with Graves' disease. A small lighted microscope is used to look at the voice box to determine how the vocal cords of the voice box are functioning.

Even though a patient does not report change in their voice does not insure that the vocal cords are working normally. A vocal cord that is paralyzed greatly increases the concern that a thyroid may be hiding a thyroid cancer.

Examination of your eyes may be required by a qualified ophthalmologist if you are having any visual symptoms. If you possibly have Graves' disease and your blood tests also demonstrate that your thyroid hormone level is too high hyperthyroidism , this is when a radioiodine scan thyroid scan is indicated.

In these cases, the thyroid stimulating hormone TSH will be very low and in cases of Grave's disease, the thyroid stimulating immunoglobulin will be very high. The Graves' disease patient may or may not have recognized symptoms of their hyperthyroidism. During the thyroid scan, the patient will be given a small amount of radioactive iodine in a pill and a special imaging camera is utilized to determine how much iodine is taken up by the thyroid gland and if the thyroid takes up iodine throughout the thyroid gland or whether there is a single "hot" area in the thyroid, relative to the remainder of the thyroid gland this is called a "hot nodule".

A high uptake of iodine by the thyroid gland is suggestive of Graves' disease or hyperthyroidism. If a thyroid nodule has less iodine uptake than the rest of the thyroid gland, then the thyroid nodule is called a "cold nodule". In patients with multinodular goiter, frequently several of the nodules of the thyroid will be cystic and filled with fluid. These cystic areas of a multinodular thyroid are expected to take up less iodine than the rest of the gland and appear "cold".

If you are having symptoms from your eyes, your doctor may order a CT or MRI of the orbit and skull base in order to determine the impact of the Graves' disease upon the eye, eye muscles, orbital fat, and surrounding structures.

A comprehensive compilation of all physical examination and tests is utilized to make a diagnosis of Graves' disease. Your doctor will likely prescribe you a medication to control your hyperthyroidism. There are two medications which are commonly prescribed to control hyperthyroidism. The first is methimizole and the second is propthiouracil PTU. These drugs prevent the thyroid from making thyroid hormone. Treatment can be pharmacologic, using anti-thyroid drugs, or ablative, with either radioiodine or thyroidectomy.

Adjunctive therapy includes symptom control with beta-blocker agents, as well as steroid supplementation, especially in patients with orbitopathy undergoing radioablative treatment. Women are most commonly affected, with a prevalence five to 10 times higher than in male peers. The most common age of presentation is between the fifth and sixth decades of life. Both of these occur as a result of local tissue infiltration by inflammatory cells and deposition of glycosaminglycanes.

Clinical manifestations. Thyroid dermopathy localized dermal myxedema can occur in 0. This CT image from a patient with Graves disease shows bilateral proptosis and orbital fat deposition.

Hospitalists should be aware of thyroid storm. It is generally manifested by fever due to severe thermogenesis , atrial tachyarrhythmias due to hyperadrenergic response , mental status changes, and liver dysfunction.

In addition, patients with thyroid storm might present with hyperglycemia, hypercalcemia, hypocortisolism, and hypokalemia. Following initiation of treatment, TSH levels remain suppressed for approximately two to three months, even after free T3 and T4 levels return to normal or below normal.

After this period of suppression is over, TSH levels can be used to adjust therapy. A thyroid radioiodine-uptake study provides a measure of iodine uptake, as well as an image of functioning thyroid tissue; the imaging is done 24 hours after the intake of iodine or iodine In patients with large goiters, when there are signs or symptoms of upper airway or thoracic outlet obstruction, imaging with a neck and upper-chest CT scan is recommended.

The underlying thyroid disorder can be treated with such anti-thyroid drugs as thionamides methimazole or propylthiouracil , ablative radioiodine, or surgical excision of the thyroid.

Advertising revenue supports our not-for-profit mission. This content does not have an English version. This content does not have an Arabic version. Diagnosis To diagnose Graves' disease, your doctor may conduct a physical exam and check for signs and symptoms of Graves' disease. Your doctor may also order tests including: Blood tests. Request an Appointment at Mayo Clinic. Share on: Facebook Twitter.

Show references AskMayoExpert. Mayo Clinic; Graves' disease. Accessed April 9, Jameson JL, et al. In: Harrison's Principles of Internal Medicine. The McGraw-Hill Companies; Accessed June 5, Papadakis MA, et al. Endocrine disorders. McGraw-Hill Education; Davies TF. Pathogenesis of Graves' disease. Kahaly GJ, et al. European Thyroid Journal. Ross DS, et al. Bobanga JD, et al. Treatment of patients with Graves' disease and the appropriate extent of thyroidectomy.

Morrow ES. Allscripts EPSi. Mayo Clinic. May 18, Nguyen CT, et al. Graves' hyperthyroidism in pregnancy. Current Opinion in Endocrinology, Diabetes, and Obesity.