How to diagnose Graves' disease (2023)

Graves' disease is a chronic autoimmune disease that causes hyperthyroidism, a condition characterized by overproduction of thyroid hormones and an enlarged thyroid gland.

Get an accurate diagnosis forMorbus Basedowis vital as it will help prevent long-term complications and provide the most effective treatments.

For those presenting with Graves-specific symptoms, the diagnosis is generally straightforward. For some, a diagnosis can be made after a few doctor visits and a blood test.

However, others may need to undergo numerous tests to rule out other conditions.

Diagnosis: when to seek medical advice?

Since thyroid hormones influence many functions of the body, the symptoms of Graves' disease are varied.

Some of the common symptoms of hyperthyroidism that people with Graves' disease experience are:

• anxiety or irritability

• A trembling in the hands

• weight loss

• goiter (an enlarged thyroid gland)

• Changes in the menstrual cycle

• fatigue

• Low sex drive

• Frequent bowel movements

• A fast and irregular heartbeat

• sleep disturbance

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Graves' disease can also cause two disorders that come with their specific symptoms. These are:

• Graves' ophthalmopathy: an eye condition that causes vision loss, bulging, itchy, and/or swollen eyes

• Graves dermopathy¹: a skin condition that causes thick, red, and swollen skin on the shins and backs of the feet.

If you're experiencing general or specific symptoms, it's important to see your doctor for an evaluation.

What kind of doctors are involved in diagnosing Graves' disease?

• Your GP, who will perform a physical exam, discuss your medical and family history, and refer you for an exam.

• An endocrinologist (a doctor who specializes in diseases that affect hormones).

• A radiologist (a specialist who reviews and reports the results of imaging).

How is Graves' disease diagnosed?

Graves' disease is usually easy to diagnose, particularly when the symptoms of Graves' ophthalmopathy and/or Graves' dermopathy are evident. For some people, e.g. However, the disease can manifest itself in different ways in people such as the elderly².

The first step in diagnosing Graves' disease is diagnosing hyperthyroidism. Once this is confirmed, the underlying cause of hyperthyroidism can be uncovered.

Graves' disease is the most common cause of hyperthyroidism. However, there are many other causes that produce similar signs and symptoms.

This means you may need to undergo multiple diagnostic tests to rule out other causes of hyperthyroidism and related conditions, such as:

• A tumor in the thyroid or pituitary gland

• Painless thyroiditis

• Plummer disease

• Excess iodine from food

• Side effects of certain medications.

Physical examination

The first step in making a diagnosis is to visit your family doctor.

They will discuss with you your family history of hyperthyroidism and/or Graves' disease, as family history is a strong risk factor³ for developing Graves' disease. Your doctor will also discuss your personal medical history and current symptoms, and ask you questions such as:

• How long have you had symptoms?

• How often do you have symptoms?

• Are you taking any new medication?

• What symptoms do you have (including common symptoms of hyperthyroidism and Graves-specific ophthalmopathy and dermopathy)?

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Your doctor will also perform a physical exam, during which he/she will:

• Feel your thyroid for signs of goiter caused by hyperthyroidism (in Graves' disease, the entire gland appears enlarged).

• Measure your pulse.

• Check your eyes for irritation or bulging.

Diagnosetest

Once your doctor has completed an evaluation and thinks that hyperthyroidism like Graves' disease is likely, they will refer you for further testing.

This could include:

Thyroid hormone blood tests

These blood tests are important to confirm generalized hyperthyroidism.

Thyroid Stimulating Hormone (TSH)

TSH is produced by the pituitary gland. It stimulates the thyroid gland to produce thyroid hormones.

Normal TSH levels range from 0.5 - 4.0 mU/L.³ Lower levels indicate hyperthyroidism, as is the case in Graves' disease.

If the TSH values ​​are abnormal, two other hormones can then be measured:

Trijodthyronin (T3)

T3 is a thyroid hormone produced by the thyroid gland. It is responsible for many processes in the body, from growth and development to metabolism and regulating body temperature.

The T3 circulating in the blood is called “free T3”. Normal free T3 values ​​range from 2.3 - 4.2 pg/ml.³ In hyperthyroidism, including Graves' disease, T3 levels are higher.

Thyroxin (T4)

T4 is another thyroid hormone that is produced in the thyroid gland. Like T3, it is responsible for many physiological processes throughout the body.

Normal levels of free T4 range from 0.8 - 1.8 ng/d³ As with T3, higher T4 levels are indicative of hyperthyroidism.

Based on the results of these tests alone, it can be difficult to distinguish Graves' disease from other causes of hyperthyroidism. A free T3/T4 ratio greater than 0.3 SI² units may indicate Graves' disease.

However, it's also possible for people with Graves' disease to have subclinical hyperthyroidism,⁴ in which TSH levels are low but T3 and T4 are still within the normal range.

Therefore, additional diagnostic tests are important.

Anti-thyroid antibody tests

Morbus Basedowis an autoimmune disease characterized by anti-thyroid autoantibodies, which are proteins produced as part of our immune response.

In a normal immune response, foreign proteins called antigens stimulate the production of antibodies. These antibodies recognize, bind to, and remove the antigens from the body, preventing disease or toxicity.

However, autoantibodies are produced in autoimmune diseases. These fight the body's own healthy proteins, which are mistakenly perceived as foreign antigens. This occurs in Graves' disease, where anti-thyroid autoantibodies are produced to attack proteins in the cells of the thyroid gland.

Die wichtigen Anti-Schilddrüsen-Antikörper bei Morbus Basedow sind:

Thyroid Stimulating Immunoglobulin (TSI)

TSI belongs to the thyrotropin receptor autoantibodies (TRAb). It is detected in 90% of people⁴ with Graves' disease.

TSI binds to and stimulates the thyroid hormone receptor (TSHR). It mimics TSH and causes the thyroid to become more active, leading to overproduction of the thyroid hormones T3 and T4 and enlargement of the thyroid gland.

This antibody is measured by a blood test. The normal range of TSI is below 130%³

In addition to being a diagnostic tool for Graves' disease, TSI is also useful for assessing:

• How likely is it that someone with Graves' disease will relapse after treatment.

• The risk of Graves' disease in pregnant women.

TSI can also contribute to the symptoms associated with Graves' ophthalmopathy and Graves' dermopathy.

Anti-thyroglobulin antibodies (TgAb)

TgAb is an antibody that fights thyroglobulin, a protein made by the thyroid gland that helps it produce thyroid hormone. It is detected in about 50% of people with Graves' disease.⁵

It is measured by a blood test.

Anti-thyroid peroxidase antibody (TPOAb)

TPOAb is an antibody that fights thyroid peroxidase, an enzyme made by the thyroid gland to help produce thyroid hormones. It is detected in more than 95% of Graves' disease patients and measured by a blood test.

These autoantibodies are not usually detected in people with overactive thyroids that are unrelated to autoimmunity.

However, it is important to remember that these antibody tests, particularly TPOAb and TgAb, are not always the most reliable for diagnosing Graves' disease. Because the antibodies can also be detected in other autoimmune diseases such as Hashimoto's disease or type I diabetes. Occasionally, these antibodies are also detected in the general population.

Scans and imaging tests

Acceptance test for radioactive iodine

The radioactive iodine uptake test shows how well the thyroid is working. The speed at which the thyroid absorbs iodine is determined. Iodine is a mineral used by the thyroid to produce thyroid hormones.

The test involves taking radioactive iodine by mouth or through an intravenous line, where it's delivered through a small tube into your vein. Once it's in your system, a device called a gamma probe is placed near the thyroid gland in your neck.

Typically, results range from 3% to 16%⁶ (percentage of iodine intake) six hours after ingesting iodine. 24 hours after ingestion, normal results range from 8% to 25%. In Graves' disease, the thyroid takes up too much iodine when antibodies bind to the TSH receptor, so the results show higher levels of radioactivity.

The radioactive iodine uptake test is not recommended for pregnant or breastfeeding women because exposure to radioactive material can be harmful to the fetus or baby. In addition, you should notify your doctor if you have diarrhea, as it can decrease radioactive iodine absorption and make the test less accurate.

This test requires some preparation. For a week before the test, you must avoid foods and supplements that either contain iodine or increase the amount of iodine absorbed by the thyroid.

In addition, the radioactive iodine uptake test must be combined with other types of tests because high uptake can be associated with other hypothyroid conditions such as a toxic thyroid nodule.

Thyroid ultrasound

Ultrasound uses sound waves to create images of internal body structures, such as the thyroid gland. The resulting image can then be analyzed to determine how enlarged the thyroid is. For pregnant women, this test is safer than the radioactive iodine uptake test.

Ultrasound is a simple, quick, and non-invasive test that requires no preparation on your part.

Doppler-Ultraschalltest

A Doppler ultrasound is similar to ordinary ultrasound, which uses sound waves to create an image of internal body structures.

However, a Doppler ultrasound measures sound waves reflected frommoving objectsin the body, like red blood cells. This is then used to visualize the amount of blood flowing through the blood vessels.

Graves' disease causes increased blood flow in the thyroid gland. This is called a "thyroid inferno," where there are several small areas of increased blood flow scattered throughout the thyroid.

This is a useful diagnostic tool because other types of thyroid problems can lead to decreased blood flow to the thyroid gland.

Doppler ultrasound is not suitable for pregnant and breastfeeding women. This is because, unlike ordinary ultrasound, Doppler ultrasound carries a higher risk of thermal damage to fetal tissues.

Other imaging tests

Imaging tests, such as CT and MRI scans, are useful to identify other causes of hyperthyroidism, such as B. thyroid tumors to rule out.

They can also be used to examine the eye muscles if you have eye swelling, which can be caused by Graves' ophthalmopathy, a complication of Graves' disease.Imaging tests can also help distinguish Graves' ophthalmopathy from other eye disorders.

Finally, these tests can help distinguish Graves' early inflammatory stage from the inactive stage.

Thyroid isotope scan

A thyroid isotope scan is an imaging test that uses radioactive iodine. It is often done at the same time as a radioactive iodine uptake test.

This scan may show:

• The distribution of iodine in the thyroid.

• The size, shape, and position of the thyroid gland.

• Whether there are thyroid nodules that are over-producing thyroid hormone (these areas will glow more brightly).

In Graves' disease, iodine is evenly distributed throughout the thyroid gland. However, under some other conditions, iodine becomes concentrated in a specific area of ​​the gland.

Thyroid isotope scans are not recommended for pregnant or breastfeeding women due to the risk of fetal radiation exposure.

Based on these tests, diagnostic criteria⁸ for Graves' disease have been proposed. These state that a person with too much thyroid hormone in their body who has one or more of the following could be diagnosed with Graves' disease:

• Detectable TRABs in the blood

• Evidence of Graves ophthalmopathy and/or Graves dermopathy

• Spread and increased uptake of radioactive iodine.

The facts

If you have symptoms of an overactive thyroid, it is recommended that you see your doctor as soon as possible so that a prompt diagnosis can be made.

Left untreated, Graves' disease can lead to serious complications such as heart failure, osteoporosis, infertility, and a potentially fatal "thyroid storm," in which your heart rate, blood pressure, and body temperature can quickly rise to dangerous levels.