Conventionally, Graves' disease is viewed as a disease in which the predominant signs and symptoms are tremor, tachycardia, enlargement of the thyroid gland and exophthalmos. Of lesser importance are loss of weight, diarrhea and sweating, pigmentation, a relative lymphocytosis and, in severe cases, fever and jaundice. It is generally agreed that such patients are "nervous," irritable and restless, and that they sleep poorly. As a rule, the disease is accompanied by an increased basal metabolism.The diagnosis of Graves' disease is simple when the cardinal signs are present. Clinically, however, one meets patients in whom one or the other of these signs is absent; for instance, one frequently sees patients with tremor, tachycardia and enlarged thyroid gland without exophthalmos (23.2 per cent, Sattler1) and others with tremor, tachycardia and exophthalmos but without an enlargement of the thyroid. Nevertheless, clinicians have tacitly included such patients within the province of of
MOSCHCOWITZ E. THE NATURE OF GRAVES' DISEASE. Arch Intern Med (Chic). 1930;46(4):610–629. doi:10.1001/archinte.1930.00140160060007
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