Mrs Jones went to see her GP as she had noticed she had lost weight even though she felt she was eating more. On examination Mrs Jones had sweaty, erythematous plams, a rapid and bounding pulse and upper lid retraction.

Following further examination and investigations a diagnosis of Graves' disease was made, which of the following is most closely linked with Graves' disease?

A) Diarrhoea

B) Increased free T3

C) Dysphagia

D) Fever

E) Pretibial myxoedema

The answer is E. Although all of the possible answers are associated with hyperthyroidism, only pretibial myxoedema is associated with Graves' disease. Graves' disease is an autoimmune cause of hyperthyroidism and commonly presents with opthalmic changes but can also present with demopathy [pretibial myxoedema] and acropachy [clubbing, onycholysis].