Graves' disease C017

Current RMA Instruments

Changes from previous Instruments

ICD Coding

• ICD-10-AM Codes: E05.0

Brief description

Graves disease is an autoimmune disease, mainly of the thyroid gland.  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 myxoedema.

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, but covers other causes of thyroid overactivity.  There is also a separate SOP for goitre, which also excludes Graves disease.  All manifestations of Graves disease are covered by the Graves disease SOP (only).

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 disease
• Exophthalmic goitre
• Eye and skin manifestations of Graves’ disease
• Graves orbitopathy
• Pretibial myxoedema
• Thyrotoxic crisis due to Graves disease

Additional diagnoses which may be covered by SOP

• Diffuse toxic goitre - Graves disease is the commonest cause

Conditions not covered by SOP

• Hashimoto 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 abnormal thyroid function (including thyrotoxic crisis) or goitre, or the eye or skin manifestations.