Synopsis
Confirm Graves autoimmunity, select antithyroid or definitive treatment with reproductive safeguards, and identify thyroid eye disease requiring urgent sight-saving specialist care.
- Graves disease is TSH-receptor-antibody-mediated hyperthyroidism and may cause diffuse goitre, thyroid bruit, eye disease, dermopathy and rarely acropachy.
- Confirm biochemical thyrotoxicosis with TSH, free T4 and free T3, then use TRAb as the NICE-recommended confirmatory test.
- A course of carbimazole is commonly used, with NICE describing 12 to 18 months when antithyroid medicine is chosen as definitive treatment in adults.
Key red flags
Reduced central or colour vision, new visual-field defect, relative afferent pupillary abnormality or optic-disc change can result from apical compression, sometimes without dramatic proptosis.
Investigation priorities
Establish severity and follow biochemical response to treatment.
Management branches
Clinical and biochemical findings suggest Graves disease without storm.
- Measure TRAb, document cardiac and eye status, check pregnancy possibility and obtain baseline full blood count and liver tests before thionamide treatment.
- Use BNF-checked carbimazole and symptom control under the local pathway, with explicit infection, liver, pancreatitis and reproductive safety-netting.
Key medicines
Carbimazole for Graves hyperthyroidismThe adult starting total is commonly 15 to 40 mg daily in the current BNF, selected by biochemical severity; subsequent titration or block-and-replace requires the agreed endocrine regimen.
Propranolol for short-term symptom reliefUse a BNF-verified oral regimen commonly within 10 to 40 mg three or four times daily, titrated to symptoms and pulse while monitoring blood pressure.