**4. Diagnosis**

Diagnosis of GD is complex and difficult. The combined effect of several symptoms and symptoms leads the doctor to suspect the thyroid irregularity. Comprehensive history such as intake or exposure to iodine, drugs, thyroid and autoimmune history and physical exam, vital signs such as pulse rate measurement, blood pressure measurement, respiratory and body weight. Moreover, the presence or absence of a thyroid tenderness, symmetry and nodularity should also be evaluated; pulmonary, cardiac and neuromuscular function and the presence of eye signs or pretibial myxedema. Because hyperthyroidism is frequently associated with low or undetectable levels of TSH, it is an easy biochemical diagnosis to make if thyrotoxicosis is found. T4 and T3 are usually high, but are relatively higher in GD serumT3 than T4. The T4 and T3 concentration levels are usually high. In mild forms of hyperthyroidism and during earliest phases of DG only serum T3 levels can be enhanced (T3 toxicosis). The removal of the lid, anxiety, an increase in neck volume, signs of involvement with the eye and the history of autoimmune disease in the family also distinguish GD from other types of hyperthyroidism (e.g., toxin goiter, toxic adenoma) (e.g., silent or subacute thyroiditis, exogenous thyroid hormone use). Serum measurement of the TSH-receptor automatic antibody (TRAb) helps confirm diagnosis. New bioassays for the thyroid stimulant immunoglobulin (TSI) especially aid in the measurement of TSI's ability to increase the intracellular cAMP level by detecting stimulating antibodies. Radioactive Iodine uptaking (RAIU), despite a clinical examination, thyroid function evaluation and TRAb detection should only be carried out when the diagnosis is unclear. The pattern for iodine uptake in GD is diffuse if no coexisting nodules or fibrosis do not occur. Technetium 99 can be of assistance. Increased color Doppler flow supports thyroid hyperactivity diagnosis. In case of thyroid nodularity in the neck or in a thyroid scintigram, thyroid scan must be conducted.
