Published November 14 2016
Graves’ Disease is an autoimmune hyperthyroid condition that is usually easy to diagnose. However, every now and then I’ll work with a patient who has been misdiagnosed. For example, they might have been told they have Graves’ Disease when this isn’t the case. Or perhaps they were told they didn’t have Graves’ Disease, even though they do have this condition. In this article I’ll discuss the three common ways that Graves’ Disease is diagnosed, and I will also talk about the accuracy associated with each method, along with the limitations.
So here are three ways that Graves’ Disease is commonly diagnosed:
1. Elevated thyroid stimulating immunoglobulins. The thyroid stimulating immunoglobulins are the antibodies associated with Graves’ Disease. If someone has hyperthyroidism, along with elevated thyroid stimulating immunoglobulins, then this is diagnostic of Graves’ Disease. As a result, everyone who is diagnosed with hyperthyroidism should get these antibodies tested as a next step. But unfortunately many endocrinologists don’t recommend for the thyroid stimulating immunoglobulins to be tested, but instead will recommend the radioactive iodine uptake scan, which I’ll discuss next.
Some endocrinologists will recommend both the thyroid stimulating immunoglobulins and the radioactive iodine uptake test. The problem I have with this is that if the thyroid stimulating immunoglobulins are elevated then this pretty much confirms that the person has Graves’ Disease, and thus it is unnecessary for the person to receive the radioactive iodine uptake scan. I’ll expand on this next.
I will say that it is possible for some people with Graves’ Disease to have a false negative antibody reading. In other words, the thyroid stimulating immunoglobulins might test negative at times in those who do have Graves’ Disease. If this is the case then doing the radioactive iodine uptake test might be a good idea, although sometimes if someone does another test for thyroid antibodies a month or two later this will show up as being positive. One can also test the thytrophin receptor antibodies (TRAB), as if these are positive in hyperthyroidism then this pretty much confirms the presence of Graves’ Disease. Thyroid stimulating immunoglobulins are a type of TSH receptor antibody.
2. Elevated radioactive iodine uptake. In most cases of Graves’ Disease there will be an elevated radioactive iodine uptake test. However, there are a few reasons why I don’t recommend for most people with hyperthyroidism to get this initially. First of all, and as I already mentioned, if someone with hyperthyroidism has elevated thyroid stimulating immunoglobulins then this confirms that the person has Graves’ Disease. Some might argue that the radioactive iodine uptake scan can detect the presence of thyroid nodules, which is true, but an ultrasound can do this as well. And while a radioactive iodine uptake scan can detect “hot” and “cold” nodules, which can possibly indicate if the nodules are benign or malignant, a malignancy still would need to be confirmed through other methods, such as a biopsy.
A second reason why the radioactive iodine uptake scan shouldn’t be given initially is because an elevated reading doesn’t always confirm the presence of Graves’ Disease, and “normal” readings don’t always rule out Graves’ Disease. Some endocrinologists will recommend for their patients with hyperthyroidism to obtain both the radioactive iodine uptake scan and the thyroid stimulating immunoglobulins. But as I mentioned earlier, if the TSI levels are elevated then there usually is no good reason to do the radioactive iodine uptake scan.
A third reason why this test shouldn’t be routinely recommended to those with hyperthyroidism is because it involves radioactive iodine. And while this involves a very small dosage of radioactive iodine, if we can get the information we need from testing the thyroid stimulating immunoglobulins and doing an ultrasound, then why expose someone to radioactive iodine, even if it is a small amount?
3. The presence of thyroid eye disease. If someone has hyperthyroidism and obvious signs and symptoms of thyroid eye disease, then this is a very strong indication that the person has Graves’ Disease. In this situation I’d still recommend for the person to get the thyroid stimulating immunoglobulins tested. With moderate to severe cases of thyroid eye disease the TSI levels are usually quite elevated.
How To Differentiate Graves’ Disease From Other Hyperthyroid Conditions
Now that I have discussed three methods of diagnosing Graves’ Disease, I’d like to briefly discuss how to differentiate this autoimmune hyperthyroid condition from other hyperthyroid conditions.
Subacute thyroiditis. With subacute thyroiditis the thyroid stimulating immunoglobulins should be negative, and if a radioactive iodine uptake scan is performed it usually won’t be elevated, as the reading will usually be low. Plus, the person most likely won’t have any thyroid eye disease symptoms. In addition, the symptoms of hyperthyroidism usually are temporary, as they usually last from two to four months, and is then usually followed by a period of hypothyroidism. I talk about this condition in greater detail in an article I wrote entitled “Natural Treatment Methods For Subacute Thyroiditis [1]”.
Toxic multinodular goiter. This condition involves the presence of hyperthyroidism along with a goiter and multiple thyroid nodules. Most people with toxic multinodular goiter will also have negative thyroid stimulating immunoglobulins, although occasionally I’ll work with someone who has both Graves’ Disease and toxic multinodular goiter. But this is uncommon, as most people with this condition will have negative thyroid antibodies, won’t have the symptoms of thyroid eye disease, and if they have a radioactive iodine uptake scan this usually will reveal low readings. I spoke more about this condition in an article I wrote entitled “Multinodular Goiter and Natural Treatment Methods [2]”.
So hopefully you have a better understanding as to how Graves’ Disease is diagnosed. The best method to diagnose Graves’ Disease is by testing the thyroid stimulating immunoglobulins. Many endocrinologists recommend the radioactive iodine uptake test initially, although in my opinion this test doesn’t need to be done if someone has elevated thyroid stimulating immunoglobulins that has been confirmed through a blood test. If someone has hyperthyroidism, along with the signs and symptoms of thyroid eye disease, then this is a very strong indication that the person has Graves’ Disease.