Friday, March 22, 2024

EMS Particular Patient Presentations - Graves' Disease

EMS providers should have an understanding of Graves' Disease and its potential implications for prehospital care. 

Graves' disease is an autoimmune disorder characterized by overactivity of the thyroid gland, leading to hyperthyroidism. This condition is caused by autoantibodies that stimulate the thyroid gland to produce excessive amounts of thyroid hormone.

In terms of prehospital care, EMS providers should be aware of the signs and symptoms of Graves' disease, which may include:

Hyperthyroid Symptoms: Patients with Graves' disease may exhibit symptoms such as rapid heartbeat (tachycardia), palpitations, tremors, heat intolerance, excessive sweating, weight loss despite increased appetite, and fatigue.

Ophthalmic Manifestations: Graves' disease can also cause eye-related symptoms known as Graves' ophthalmopathy or thyroid eye disease. These symptoms may include bulging eyes (exophthalmos), eye irritation, redness, double vision, and vision changes.

Thyroid Gland Enlargement: Some patients with Graves' disease may have a visibly enlarged thyroid gland (goiter) due to thyroid hyperplasia or nodular growth.

Psychological Symptoms: Patients may experience anxiety, irritability, mood swings, and difficulty concentrating due to the effects of excess thyroid hormone on the nervous system.

In terms of potential issues for prehospital care, EMS providers should consider the following:

Cardiovascular Complications: Patients with Graves' disease may be at increased risk of cardiovascular complications such as atrial fibrillation, heart failure, or cardiac arrest due to the effects of excess thyroid hormone on heart function.

Thyroid Storm: In severe cases, Graves' disease can lead to a life-threatening condition known as thyroid storm, characterized by severe hyperthyroidism and systemic decompensation. EMS providers should be prepared to recognize and manage thyroid storm promptly, including supportive measures and administration of medications to control thyroid hormone levels.

Ophthalmic Emergencies: Patients with Graves' ophthalmopathy may present with severe eye symptoms requiring immediate attention, such as corneal ulceration, optic nerve compression, or vision loss. EMS providers should be prepared to provide appropriate eye care and ensure prompt transport to a facility capable of managing ophthalmic emergencies.


The discovery of Graves' disease is credited to Dr. Robert J. Graves, an Irish physician. 

Dr. Graves first described the condition in 1835 in a paper titled "New Observations on the Diseases of the Thyroid Gland," where he detailed the clinical features of patients with hyperthyroidism associated with goiter and ophthalmic manifestations. 

Dr. Graves' pioneering work laid the groundwork for understanding and diagnosing Graves' disease, and he is recognized as a key figure in the history of endocrinology.

Further Reading:

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice Volume 1 (6th Ed) Pearson.  

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

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