All are true for Grave’s disease except: March 2012
**Core Concept**
Grave's disease is an autoimmune disorder characterized by hyperthyroidism, resulting from the production of autoantibodies that stimulate the thyroid-stimulating hormone receptor (TSH-R). This leads to excessive production of thyroid hormones, primarily triiodothyronine (T3) and thyroxine (T4).
**Why the Correct Answer is Right**
The correct answer is one of the options that does not accurately describe a characteristic of Grave's disease. The disease is indeed associated with exophthalmos (bulging eyes), goiter (enlargement of the thyroid gland), and tachycardia (rapid heart rate). The presence of autoantibodies against the TSH-R and the subsequent increase in thyroid hormone production are key features of the disease.
**Why Each Wrong Option is Incorrect**
**Option A:** Exophthalmos is a common feature of Grave's disease.
**Option B:** Goiter is often present in patients with Grave's disease.
**Option C:** Tachycardia is a symptom associated with the increased metabolic rate caused by excess thyroid hormones.
**Clinical Pearl / High-Yield Fact**
To differentiate Grave's disease from other causes of hyperthyroidism, it's essential to perform a thorough physical examination, including assessment of eye movements and the presence of exophthalmos.
**Correct Answer:** D