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Keith Forwith

Innovative Thyroid Surgeon

Evaluating Hyperthyroidism: The Workup for Graves’ Disease

One of the first steps in evaluating hyperthyroidism is to obtain some routine laboratory workup. The most sensitive test for detecting excess thyroid hormone is the TSH (Thyroid stimulating hormone) exam. T4 should also be evaluated. T3 is the active form of thyroid hormone while T4 is the storage form of thyroid hormone. Neither T3 or T4 levels correlate directly with symptoms! Don’t let anyone tell you how bad your symptoms are based on lab tests! Typically, in Graves’ disease high levels of both T3 and T4 will be seen. There are several antibodies that contribute to hyperthyroidism, the most prevalent is thyrotropin receptor antibody, often abbreviated as TRAb. Ninety-six percent of patients with Graves’ disease are positive for the TRAb antibody. As part of the workup for Graves’ disease, your doctor will evaluate your pulse rate, blood pressure, respiratory rate.

Graves Disease Affects Many People Differently

Body weight changes are frequent with hyperthyroidism and while classically Graves’ disease can produce unintentional weight loss, there are many patients who experience weight gain with Graves’ disease. Many patients experience increased appetite – which can easily lead to weight gain, not loss. Graves disease can result in enlargement of the thyroid gland seen low in the neck. The thyroid gland can be tender and can be either symmetric or asymmetric. There may be nodules associated with Graves’ disease and an irregularity to the thyroid gland. In severe cases, the thyroid gland can cause compression of both the trachea and the esophagus. This would produce symptoms of exertional shortness of breath or difficulty swallowing.

Graves Can Affect Breathing and Heart Function

Frequently, there are pulmonary symptoms associated with Graves’ disease. Rapid heart rate is often accompanied by a feeling of shortness of breath or a fast rate of breathing. Neuromuscular dysfunction is common in the setting of severe Graves’ disease. Swelling around the eyes is common, while swelling in the shins is an uncommon but well-known complication of Graves’ disease. Cardiac workup is frequently needed including EKG and possible echocardiogram, Holter monitor or myocardial perfusion studies. Typically, Graves’ disease gives an elevated heart rate and it is not unusual for heart rates to exceed 100 at rest in the Graves’ patient.

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