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Reliable, easy-to-read patient information on common medical conditions — written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.

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Graves' disease diagnostic approach

Introduction

Overview

Overview

A detailed evaluation of a patient with clinical symptoms of hyperthyrodism must be done in order to make an accurate diagnosis.

Diagnostic approach

Diagnostic approach

  • In the presence of relative clinical symptoms and signs for hyperthyroidism, a diagnostic approach must be taken to accurately diagnosis and manage the disease.[1][2][3]
  • The following algorithm summarizes the diagnostic approach for suspected hyperthyroidism.
 
 
 
 
 
 
 
 
 
 
 
 
 
Suspected Hyperthyroidism
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Measure serum TSH and free T4
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Normal TSH & free T4
 
↓ TSH & ↑ free T4
 
 
 
 
 
 
 
↓ TSH & Normal free T4
 
Normal or ↑ TSH & ↑ free T4
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Hyperthyroidism ruled out
 
Hyperthyrodism
 
 
 
 
 
 
 
Measure free T3
 
TSH secreting pituitary tumor,
Thyroid hormone resistance
or Assay interference
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Measure TSH receptor antibodies
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
↑ free T3
 
Normal free T3
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Present
 
Absent
 
 
 
T3 Toxicosis
 
Sub-clinical Hyperthyrodism
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Graves’ Disease
 
Assess radioiodine uptake,
obtain radionuclide scan,
or both
 
 
 
 
 
 
 
Evolving Graves’ disease,
Evolving toxic nodular goiter,
Excess thyroid hormone intake, or
Non thyroidal illness
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Homogeneous
increased uptake
 
Patchy uptake
or single nodule
 
Low or no uptake
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Graves disease
 
Toxic nodular goiter
 
Subacute thyroiditis,
Excess thyroid hormone intake, or
HCG secreting tumor
 
 
 
 
 
 
 
 

The presence of at least one of the following findings in a hyperthyroid patient is definitive for Graves’ disease:[4]

  • Detectable TSH receptor antibodies (TRAbs) in the serum
  • Evidence of ophthalmopathy and/or dermopathy
  • Diffuse and increased RAIU
References

References

  1. ↑ Tozzoli R, Bagnasco M, Giavarina D, Bizzaro N (2012). “TSH receptor autoantibody immunoassay in patients with Graves’ disease: improvement of diagnostic accuracy over different generations of methods. Systematic review and meta-analysis”. Autoimmun Rev. 12 (2): 107–13. doi:10.1016/j.autrev.2012.07.003. PMID 22776786.
  2. ↑ Pedersen IB, Knudsen N, Perrild H, Ovesen L, Laurberg P (2001). “TSH-receptor antibody measurement for differentiation of hyperthyroidism into Graves’ disease and multinodular toxic goitre: a comparison of two competitive binding assays”. Clin. Endocrinol. (Oxf). 55 (3): 381–90.
  3. ↑ Terry J. Smith & Laszlo Hegedus (2016). “Graves’ Disease”. The New England journal of medicine. 375 (16): 1552–1565. doi:10.1056/NEJMra1510030. PMID 27797318. Unknown parameter |month= ignored (help)
  4. ↑ Shoenfeld, Yehuda (2014). Diagnostic criteria in autoimmune diseases. Place of publication not identified: Humana. ISBN 978-1627038584.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]