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Graves' disease C017

Document
Last amended 
1 August 2019
Current RMA Instruments
Reasonable Hypothesis SOP
33 of 2013 as amended
Balance of Probabilities SOP
34 of 2013 as amended
Changes from previous Instruments

SOP Bulletin 165

ICD Coding
  • ICD-9-CM Codes: 242.0
  • ICD-10-AM Codes: E05.0
Brief description

Graves' disease is an autoimmune disease.  Autoantibodies develop that bind to the thyrotropin receptor resulting in thyroid growth and overproduction of thyroid hormone.  Graves' disease typically manifests with hyperthyroidism, goiter (enlarged thyroid), eye disease (orbitopathy), and occasionally a skin condition referred to as pretibial or localized myxedema.

Graves’ disease is the commonest cause (60-80%) of hyperthyroidism in Western countries. There is a separate SOP for hyperthyroidism and thyrotoxicosis,  which excludes Graves' disease and covers other causes of thyroid overactivity.

Confirming the diagnosis

Diagnosis is based on clinical manifestations together with blood tests assessing thyroid function and the presence of thyroid antibodies.

The relevant medical specialist is an endocrinologist. 

Additional diagnoses covered by SOP
  • Basedow’s disease
  • Diffuse toxic goitre
  • Exophthalmic goitre
  • Eye and skin manifestations of Graves’ disease
Conditions not covered by SOP
  • Hashimoto's thyroiditis*
  • Hyperthyroidism (other than due to Graves’ disease)* - hyperthroidism and thyrotoxicosis SOP
  • Hypothyroidism* 
  • Goitre* (other than due to Graves’ disease)
  • Thyrotoxicosis (other than due to Graves’ disease)* - hyperthroidism and thyrotoxicosis SOP

* another SOP applies

Clinical onset

Onset may be insidious, with symptoms developing slowly.  There can be a wide array of hyperthyroidism symptoms, such as rapid heart rate, weight loss and tremor.  Buldging eyes (exophthalmos) may be the first feature to be noticed. The condition may also come to attention when a goitre (enlarged thyroid) is first noticed. 

Clinical worsening

A range of effective treatments are available.  Long term monitoring will be required after initial therapy.  Worsening would involve an increase in manifestaions of the hyperthyroidism or goitre, or the eye or skin manifestations. Development of e.g. hypothyroidism would represent onest of a new condition rather than worsening of Graves' disease.