The following symptoms and complaints may indicate Graves’ disease:
I. Symptoms of hyperthyroidism (overactive thyroid)
Leading symptomsbasic metabolic rate
- Increase in body temperature → heat intolerance or hypersensitivity to heat (thermophobia).
- Sweating
- Warm moist skin
- Weight loss (despite increased appetite)
Cardial (cardiovascular)
- Tachycardia – heartbeat too fast: > 100 beats per minute [cardiac output volume (HMV) ↑]
- Systolic blood pressure elevated (blood pressure amplitude ↑).
- Palpitations (heart palpitations)
Gastrointestinal (gastrointestinal tract)
- Diarrhea (diarrhea)
- Weight loss (due to malabsorption)
Nervous system and psyche
- Depression
- Hyperactivity
- Irritability/Nervousness
- Tremor (shaking)
- Insomnia (sleep disturbances; insomnia)
Associated symptoms
- Alopecia (hair loss, diffuse)
- Weight gain – in 5-10% of affected individuals due to increased appetite.
- Gynecomastia – enlargement of the mammary gland in men.
- Hyperreflexia
- Muscle weakness, proximal
- Fatigue, weakness
- Lack of concentration
- Loss of libido – decreasing sex drive
- Oligomenorrhea – the interval between bleeding is > 35 days and < 90 days, i.e. the period occurs too infrequently
- Palmar erythema – red coloration of the palms.
- Polyuria – frequent urination (due to increased organ blood flow: GFR ↑).
- Pruritus (itching)
- Serum cholesterol ↓
II. goiter
- Goiter (thyroid enlargement; hypervascularized) – see under goiter, if applicable.
III. endocrine orbitopathy (EO) (incidence: 40-60%)
- Exophthalmos (synonyms: endocrine ophthalmopathy; ophthalmoptosis; ophthalmopathy; protrusio bulbi; popularly known as “googly eyes”) – pathologic protrusion of the eyeball from the orbit [occurrence: before, during, or after the onset of hyperthyroidism].
- Redness of the conjunctiva (conjunctiva).
- Incomplete closure of the eyelids (lagophthalmos).
- Foreign body sensation in the eyes and increased lacrimation
- When lowering the gaze, the upper eyelid remains behind, so that in exophthalmos the part of the sclera visible above the cornea is enlarged (Graefe’s sign)
- Corneal lesions (corneal injuries).
- If necessary, eye muscle involvement and eye muscle paresis with double vision.
- When the optic nerve is compressed, there is a decrease in visual acuity (visual acuity) and limitation of color vision
IV. Dermopathy (incidence: 2-3%)
- Dermopathy – skin changes similar to orange peel skin, mostly on the lower legs.
- Pretibial (anterior to the shin) myxedema – skin (including subcutaneous and adipose tissue) is typically doughy swollen, cool, dry, and rough (especially on the extremities and face); patients look puffy.
- Acropachy – Bone thickening (due to subperiosteal bone apposition) with concomitant soft tissue thickening (painless; normal temperature) on the finger and toe end links (I-III) and onycholysis (nail plate detachment).
Merseburg Triassic
The so-called Merseburg triad of Graves’ disease is composed of the following symptoms:
- Struma
- Exophthalmos
- Tachycardia