Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Graves' Disease


Related Terms

  • Basedow's Disease
  • Diffuse Thyrotoxic Goiter
  • Exophthalmic Goiter
  • Parry's Disease
  • Thyrotoxicosis
  • Toxic Goiter

Differential Diagnosis

Specialists

  • Endocrinologist
  • General Surgeon
  • Internal Medicine Physician
  • Ophthalmologist
  • Otolaryngologist
  • Psychiatrist

Comorbid Conditions

  • Autoimmune diseases (e.g., rheumatoid arthritis, lupus)

Factors Influencing Duration

The length of disability may be influenced by the severity of the symptoms, complications resulting from the disease, and the method of treatment.

Medical Codes

ICD-9-CM:
242.00 - Thyrotoxicosis with or without Goiter; Toxic Diffuse Goiter; Basedows Disease; Exophthalmic or Toxic Goiter NOS; Graves Disease; Primary Thyroid Hyperplasia; without Mention of Thyrotoxic Crisis or Storm
242.01 - Thyrotoxicosis with or without Goiter; Toxic Diffuse Goiter; Basedows Disease; Exophthalmic or Toxic Goiter NOS; Graves Disease; Primary Thyroid Hyperplasia; with Mention of Thyrotoxic Crisis or Storm

Overview

Graves' disease is an autoimmune disease affecting the thyroid gland that results in the overproduction of thyroid hormones. The thyroid gland is an endocrine gland located in the front of the neck, near the "Adam's apple." This gland produces hormones that are important for controlling the body's metabolism. In Graves' disease, the thyroid gland becomes enlarged (goiter), and produces excessive amounts of hormones (hyperthyroidism).

If left undiagnosed or inadequately treated, Graves' disease can lead to a potentially fatal condition called thyroid storm or thyroid crisis, in which there is severe worsening of the symptoms of thyroid overactivity.

Although its cause remains unknown, Graves' disease typically follows an illness or stress, and tends to run in families. It is sometimes found in conjunction with other autoimmune diseases such as pernicious anemia, myasthenia gravis, and diabetes. Up to 50% of patients with Graves' disease may experience complete or partial relief of symptoms (spontaneous remissions).

Incidence and Prevalence: In the US, the incidence of Graves' disease is approximately 30 cases per 100,000 persons per year.

Source: Medical Disability Advisor



Causation and Known Risk Factors

Graves' disease is 8 times more common in women than men, and usually appears between the ages of 20 and 40 (Fitzgerald 1093). Specific risk factors and preventive measures cannot be identified because the exact cause of Graves' disease is unknown.

Source: Medical Disability Advisor



Diagnosis

History: General symptoms due to increased levels of thyroid hormones (hyperthyroidism) include weight loss, increased appetite, hand tremors, nervousness, restlessness, fatigue, heat intolerance, sweating, muscle cramps, breathlessness, blurred or double vision, diarrhea or frequent bowel movements, menstrual irregularities, difficulty climbing stairs, and a fluttering in the chest (heart palpitations). In rare cases, individuals may experience temporary paralysis lasting 7 to 72 hours, typically after strenuous exercise. Additional symptoms may include eye irritation, eye sensitivity, or pressure behind the eyes. Individuals may notice that their eyes appear to bulge (exophthalmos), leading to eye irritation and tearing.

Individuals in advanced stages of Graves' disease may have symptoms of thyroid storm, including rapid pulse, delirium, nausea, diarrhea, dehydration, fever, and generalized weakness (malaise).

Physical exam: The exam usually reveals an enlarged thyroid gland (goiter) and bulging of the eyeballs (exophthalmos). Other signs may include swollen glands, an irregular heartbeat, increased heart rate, and an "orange-peel" skin texture (myxedema) on the shins.

Tests: Diagnosis is confirmed by thyroid function and radioactive iodine uptake tests. Tests are available to measure thyroid hormone levels in the blood (thyroid stimulating hormone [TSH], thyroid stimulating immunoglobulin [TSI], T3, T4). In radioactive iodine uptake tests, the individual is given a small quantity of a radioactive chemical, either orally or by injection. The radioactive chemical localizes to healthy or diseased tissue, depending on the disease process and the type of scan. The radioactivity produces an image of the thyroid on film, which is then evaluated for abnormalities. A high level of radioactivity distributed evenly throughout the thyroid gland and low TSH levels in the blood confirm the diagnosis of Graves' disease.

Diagnostic imaging tests (MRI, CT scan, and ultrasound) may be recommended to rule out a thyroid tumor as the underlying cause of the hyperthyroid symptoms, or an eye tumor as the underlying cause for exophthalmos.

Source: Medical Disability Advisor



Treatment

Treatment is aimed at controlling overactivity of the thyroid gland. Antithyroid medications accomplish this by blocking the synthesis of thyroid hormones. Medications to relieve heart symptoms, sweating, and anxiety may also be prescribed. Thyroid gland overactivity can also be controlled by outpatient administration of radioactive iodine. The radioactive iodine concentrates in the thyroid gland, destroying some or all of the thyroid tissue (ablation).

Individuals who do not respond well to these approaches may need to have the thyroid gland removed surgically (thyroidectomy). Thyroid ablation and surgical removal of the thyroid gland can lead to hypothyroidism due to the underproduction of thyroid hormones.

Eye problems usually resolve with treatment of Graves' disease. Sometimes prednisone is required for severe inflammation, and eyes may need to be taped closed at night so they do not dry out. Wearing sunglasses and using eye drops may lessen irritation. Even with a good response to thyroid treatment, regular lifelong monitoring by a physician is important because of the serious complications associated with Graves' disease.

Source: Medical Disability Advisor



Prognosis

Graves' disease may subside for no apparent reason, or may result in a deficiency of thyroid hormone (hypothyroidism). Remission occurs in approximately 30% of cases treated with antithyroid drugs, usually within 5 years. Eye, heart, and psychological complications such as depression may continue even with successful treatment of the underlying thyroid disorder. Graves' disease requires life-long monitoring of thyroid hormone levels and in some cases, life-long treatment. Untreated Graves' disease or failure to take medications as directed can lead to a serious and potentially fatal condition called thyroid storm.

Source: Medical Disability Advisor



Complications

Antithyroid drugs can cause jaundice or, rarely, neutropenia. Graves' disease can cause heart disease (atrial fibrillation or congestive heart failure). Surgical removal of all or part of the thyroid gland (thyroidectomy) can result in a decrease in thyroid hormones (hypothyroidism). It can also result in vocal cord damage and permanently reduced function of the parathyroid glands (hypoparathyroidism); both of these surgical complications are rare. During treatment, individuals may experience a number of temporary side effects associated with the drugs they are taking. Radioactive iodine treatment usually results in permanent hypothyroidism, requiring treatment with thyroid hormones for life.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work restrictions or accommodations are not usually necessary. Individuals with protruding eyes (exophthalmos) may be more sensitive to bright light, fumes, wind, or dust, and may require protective eyewear or reassignment to a position where these conditions can be avoided. Exophthalmos may also cause eye irritation and dryness, which may be alleviated by frequent use of eye drops. If surgery is necessary, extended sick leave may be required during the recovery period.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Does individual have a history of hyperthyroidism?
  • Are symptoms indicative of increased thyroid hormone levels, such as weight loss, increased appetite, hand tremors, nervousness, restlessness, fatigue, heat intolerance, sweating, muscle cramps, breathlessness, blurred or double vision, diarrhea or frequent bowel movements, menstrual irregularities, difficulty climbing stairs, and a fluttering in the chest (heart palpitations)?
  • Does individual have a goiter? Are the eyes bulging (exophthalmos)?
  • Does individual have an "orange-peel" skin texture (myxedema) on the front of the shins?
  • Does individual have symptoms of thyroid storm, including rapid pulse, delirium, nausea, diarrhea, dehydration, fever, and generalized weakness (malaise)?
  • Has diagnosis been confirmed by thyroid function and radioactive iodine uptake tests?
  • Are imaging tests (MRI, CT scan, and ultrasound) required to rule out thyroid tumor or eye tumor?

Regarding treatment:

  • Have antithyroid medications been prescribed? Is the individual compliant with the treatment regimen?
  • Are medications controlling symptoms?
  • Has individual had careful follow-up to monitor thyroid hormone levels in the blood with dosage adjustments in the medication as needed?
  • Would individual benefit from radioactive iodine treatment?
  • Has surgical treatment been considered?

Regarding prognosis:

  • Based on the severity of symptoms and general health of the individual, what was the expected outcome?
  • Were the symptoms severe enough to warrant hospitalization (i.e., thyroid storm)?
  • Has individual experienced any associated complications, such as atrial fibrillation or congestive heart failure? Have these conditions been addressed in the treatment plan?
  • Did individual experience any complications associated with surgical intervention such as vocal cord damage or hypoparathyroidism?

Source: Medical Disability Advisor



References

Cited

Fitzgerald, Paul A. "Endocrinology." Current Medical Diagnosis & Treatment. 43rd ed. New York: McGraw-Hill, 2004. 1093-1093.

Source: Medical Disability Advisor






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