From the Guidelines
Graves' disease is diagnosed through a combination of clinical evaluation, blood tests, and imaging studies, with the most specific test being the measurement of thyroid-stimulating immunoglobulin (TSI) or thyroid receptor antibodies (TRAb) 1.
Diagnostic Criteria
The diagnostic criteria for Graves' disease include:
- Clinical evaluation of symptoms such as unexplained weight loss, rapid heartbeat, anxiety, tremors, and bulging eyes (exophthalmos)
- Blood tests to measure levels of thyroid-stimulating hormone (TSH), thyroid hormones (T3 and T4), and TSI or TRAb
- Imaging studies such as radioactive iodine uptake tests, thyroid ultrasound, or CT scans to visualize the enlarged thyroid gland
- Specialized eye exams to assess for Graves' ophthalmopathy in cases where eye symptoms are present
Importance of Early Diagnosis
Early diagnosis of Graves' disease is crucial to prevent serious complications, including:
- Heart problems
- Bone density loss
- Other cardiovascular- and cancer-related morbidity and mortality
Treatment
Treatment for Graves' disease typically involves antithyroid medications, such as methimazole, or nonreversible thyroid ablation therapy, such as radioactive iodine or surgery 1.
Research Gaps
Despite the common practice of detection and treatment of abnormal TSH levels, evidence is lacking on whether this approach improves important health outcomes, highlighting the need for long-term randomized, blinded, controlled trials of screening for thyroid dysfunction 1.
From the Research
Diagnostic Criteria for Graves' Disease
The diagnosis of Graves' disease is mainly based on the following criteria:
- Ultrasonography
- Laboratory diagnostics, including:
- Determination of the TSH value
- Peripheral thyroid hormones
- TSH receptor antibody (TRAb) measurement, which is highly sensitive and specific for the detection of Graves' disease 2
- Patient history
- Physical examination
- Laboratory tests, such as measurements of serum levels of TRAb and thyroid ultrasonography 3
Key Diagnostic Tests
The most important diagnostic tests for Graves' disease include:
- Measurements of serum levels of TRAb
- Thyroid ultrasonography 3
- Determination of the TSH value and peripheral thyroid hormones 2
Clinical Features
Graves' disease is characterized by:
- Goitre
- Hyperthyroidism
- Graves ophthalmopathy in 25% of patients 3
- Weight loss, tachycardia, and moist skin as common guide symptoms and clinical signs 4
- Increased sensitivity to circulating catecholamines 5
Laboratory Tests
Laboratory tests used to diagnose Graves' disease include: