"Grave's disease"

PACES candidates should know everything about Grave's disease on their fingertips. It is very common. In fact, I got it twice for PACES exam and there was always a drink beside of the patient!

Usual themes:
1. Please examine this lady who presented with palpitation for 2/52
2. This lady presented with neck swelling. Please examine.
3. Please examine this patient's thyroid status.

My advice is to divide the examination into two objectives.
First, assess the thyroid status and signs to support Grave's disease. Second, examine the neck for diffuse goitre. The sequence of examination would depends on the theme given. For theme no. 1 & 3, I would examine the thyroid status then proceed with neck examination.

Thyroid status would include:
1. Hands: pulse, sweaty palms, tremor
2. Arms: proximal myopathy, hyperreflexia
3. Eyes: lig lag, lid retraction

Points that support Grave's disease would include:
1. Diffuse goitre
2. Thyroid acropachy, onycholysis, palmar erythema
3. Exophthalmos, chemosis, ophthalmoplegia
4. Pretibial myxoedema