Graves disease — DVA SoP factors

Reasonable Hypothesis (RH) — Statement of Principles No. 7 of 2022

At least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting Graves disease or death from Graves disease with the circumstances of a person's relevant service:

1. (1)
   having iodine excess within the 6 months before the clinical onset of Graves disease;

   Note: Iodine excess may be due to consuming foods, dietary supplements or medications with a high content of iodine.

   Note: iodine excess is defined in the Schedule 1 - Dictionary.

2. (2)
   taking a drug from the specified list of drugs within the 2 years before the clinical onset of Graves disease;

   Note: specified list of drugs is defined in the Schedule 1 - Dictionary.

3. (3)
   being treated with alemtuzumab or antithymocyte globulin within the 10 years before the clinical onset of Graves disease;
4. (4)
   taking amiodarone for a continuous period of at least 6 weeks, within the 2 years before the clinical onset of Graves disease;
5. (5)
   undergoing a course of therapeutic radiation for cancer, where the thyroid gland was in the field of radiation, within the 25 years before the clinical onset of Graves disease;
6. (6)
   having received iodine-131 (radioactive iodine) for the treatment of nodular goitre within the 10 years before the clinical onset of Graves disease;
7. (7)
   having smoked tobacco products: (a) in an amount of at least 3 pack-years before the clinical onset of Graves disease; and (b) if smoking has ceased before the clinical onset of Graves disease, then that onset occurred within 10 years of cessation;

   Note: one pack-year is defined in the Schedule 1 - Dictionary.

8. (8)
   being pregnant or within the 18 months postpartum at the time of the clinical onset of Graves disease;
9. (9)
   having ethanol injection into the thyroid gland for the treatment of a thyroid adenoma within the 6 months before the clinical onset of Graves disease;
10. (10)
    having trauma to the eye within the 6 months before the clinical onset of Graves disease;

    Note: Trauma to the eye may include blunt or penetrating physical injury to the eye.

11. (11)
    for Graves disease first presenting as thyrotoxic crisis only, having an acute precipitating event within the 48 hours before the clinical onset of Graves disease;

    Note: acute precipitating event and thyrotoxic crisis are defined in the Schedule 1 - Dictionary.

12. (12)
    having iodine excess within the 6 months before the clinical worsening of Graves disease;

    Note: Iodine excess may be due to consuming foods, dietary supplements or medications with a high content of iodine.

    Note: iodine excess is defined in the Schedule 1 - Dictionary.

13. (13)
    taking a drug from the specified list of drugs within the 2 years before the clinical worsening of Graves disease;

    Note: specified list of drugs is defined in the Schedule 1 - Dictionary.

14. (14)
    being treated with alemtuzumab or antithymocyte globulin within the 10 years before the clinical worsening of Graves disease;
15. (15)
    taking amiodarone for a continuous period of at least 6 weeks, within the 2 years before the clinical worsening of Graves disease;
16. (16)
    undergoing a course of therapeutic radiation for cancer, where the thyroid gland was in the field of radiation, within the 25 years before the clinical worsening of Graves disease;
17. (17)
    having received iodine-131 (radioactive iodine) for the treatment of nodular goitre within the 10 years before the clinical worsening of Graves disease;
18. (18)
    having smoked tobacco products: (a) in an amount of at least 3 pack-years before the clinical worsening of Graves disease; and (b) if smoking has ceased before the clinical worsening of Graves disease, then that worsening occurred within 10 years of cessation;

    Note: one pack-year is defined in the Schedule 1 - Dictionary.

19. (19)
    being pregnant or within the 18 months postpartum at the time of the clinical worsening of Graves disease;
20. (20)
    having ethanol injection into the thyroid gland for the treatment of a thyroid adenoma within the 6 months before the clinical worsening of Graves disease;
21. (21)
    having trauma to the eye within the 6 months before the clinical worsening of Graves disease;

    Note: Trauma to the eye may include blunt or penetrating physical injury to the eye.

22. (22)
    for thyrotoxic crisis only, having an acute precipitating event within the 48 hours before that clinical worsening of Graves disease;

    Note: acute precipitating event and thyrotoxic crisis are defined in the Schedule 1 - Dictionary.

23. (23)
    inability to obtain appropriate clinical management for Graves disease;

Aggravation-only factors: the factors in subsections 9(12) to 9(23) apply only to material contribution to, or aggravation of, the condition where it was suffered or contracted before or during (but did not arise out of) the person’s relevant service.