Sign & Symptoms of Hyperthyroidism and Graves' disease

Signs and Symptoms of Hyperthyroidism

· Weight loss, increased appetite
· Recent onset of heat intolerance
· Agitation, nervousness
· Hot, sweaty palms
· Fine peripheral tremor
· Bounding (forceful) peripheral pulses
· Tachycardia, atrial fibrillation
· Lid retraction and lid lag
· Goitre, with or without overlying bruit
· Brisk tendon reflexes

Signs and symptoms are usually a result of increased basal metabolism rate and sympathetic activity. It is thought that the thyroid hormone increases the activity of the sympathetic system by increasing the body's sensitivity to catecholamines.
Autonomic overactivity causes increased tone and spasm of levator palpebrae superioris. This causes retraction of the upper lid as well as an abnormal following reflex where the upper lid lags well being the pupil during downward movement.

Signs and Symptoms of Graves’ disease

· Diffuse goitre with audible bruit
· Pretibial myxoedema (non-pitting oedema), finger clubbing
· Onycholysis (Plummer’s nails)
· Lid retraction, lid lag
· Proptosis, exophthalmos (a more severe form of proptosis)
· Conjuctival oedema (chemosis)

Signs and symptoms unique to Graves’ disease may be a result of antibody-mediated autoimmune reactions. It is thought that antibodies found in Graves’ disease react with antigens found in parts of the body e.g. the eye, (causing the eyes to swell and protrude) & the nails (causing separation of nail from its bed).


Comparison between Signs and Symptoms of Graves ’ disease and Toxic Nodular Goitre (another cause of hyperthyroidism)

Graves’ disease (GD) vs Nodular Goitre (NG)

Sex: Female >> Male(GD) Female = Male(NG)

EyeSigns: Very common, exophthalmos(GD) Less severe(NG)

Goitre: Smooth, diffuse, overlying bruit (GD) Uneven, may be multinodular(NG)

Heart: Tachycardia, atrial fibrillation(GD) Also angina, congestive heart failure(NG)

Weight: May lose weight(GD) Often profound weight loss(NG)

Contributed by John Lee

Source: Epstein, Clinical Examination 3rd Ed