Graves' Disease

Juan Jose Delgado Hurtado, B.S., and Marcela Pineda, B.S.
N Engl J Med 2011; 364:1955May 19, 2011

A 43-year-old woman presented with fatigue and reported a weight loss of 22.5 kg (50 lb) during the previous 18 months. Physical examination revealed diaphoresis, cachexia, a resting heart rate of 110 beats per minute, and a diffusely enlarged, nontender thyroid gland. She also had lid retraction, mild proptosis, and conjunctival injection. The patient had been aware of a mass growing in the anterior neck for the previous 6 years and had more recently noted hair loss, heat intolerance, and a resting tremor. Thyrotropin levels were suppressed, at 0.01 mIU per liter (reference range, 0.49 to 4.67). Total levels of triiodothyronine and thyroxine were elevated, at 791 ng per deciliter (reference range, 79 to 149) and more than 24 μg per deciliter (reference range, 4.5 to 12), respectively. The results of an immunoassay for levels of unbound triiodothyronine and thyroxine were not available. The patient received a diagnosis of Graves' disease. Treatment with propranolol and methimazole resulted in a substantial improvement in fatigue, tremulousness, and tachycardia within 1 week. She was thereafter lost to follow-up.

Juan Jose Delgado Hurtado, B.S.
Marcela Pineda, B.S.
Universidad Francisco Marroquin, Guatemala City, Guatemala