Graves' Disease

1 What is Graves' Disease?

Graves' disease is a disease of the thyroid gland. It is believed to be an immune system disorder that leads to the overproduction of thyroid hormones (hyperthyroidism).

Other factors are known that may lead to hyperthyroidism, Graves' disease is believed to be one of the most common cause of disease.

This is because it affects different body systems. The disease is characterized by a wide range of factors that significantly influence your overall well-being.

Although Graves' disease may affect anyone, it's however very common among women and before the age of 40.

The primary treatment targets to inhibit the overproduction of thyroid hormones and lessen the severity of symptoms.

2 Symptoms

The signs and symptoms of Graves' disease may include:

  • Anxiety and irritability,
  • one has a fine tremor of hands or fingers,
  • there is also increased heat sensitivity and an increase in perspiration or warm,
  • moist skin,
  • excessive loss of weight even when eating normally.

The thyroid glands in most of the cases becomes enlarged (goiter), the menstrual cycle changes. Erectile dysfunction or reduced libido.

There is also a frequency in the movement of the bowel. One has bulging eyes which is also referred to as graves ophthalmology. One develops thick, red skin which develops on the shin or tops of the feet (Graves' dermopathy).

It may also lead to very rapid and irregular heartbeat (palpitations). It has been shown that 30% of the people with Graves' disease have signs and symptoms of a condition known as Graves' ophthalmopathy.

It is also associated with inflammation and immune system disorders that affect the muscles and tissues around the eyes. This may lead to bulging eyes (exophthalmos).

Gritty sensation in the eyes as a result of pressure or pain in the eyes. It also forms puffy or retracted eyelids. It may also be associated with reddened or inflamed eyes. Moreover, it is associated with light sensitivity, double vision and loss of vision loss.

Graves’s dermopathy is also a rare form of the Graves’ disease. It is associated with the reddening and thickening of the skin and often the shins or tops of the feet. It is advisable to see a doctor when the signs and symptoms are associated with Graves’ disease.

If you start experiencing heart related problem’s, irregular heart beat or develop vision loss, seek emergency care.

3 Causes

Graves' disease is caused by a malfunction in the body's disease-fighting immune system, although the exact reason why this happens is still unknown. One defense mechanism is the production of antibodies that target specific virus, bacterium or other foreign substances.

In grave disease, the body produces an antibody to one part of the cell in the thyroid gland, which is the main hormone producing gland in the neck. The thyroid function is controlled by a hormone released in the brain at the pituitary gland.

The antibody associated with graves’ disease referred to as thyrotropin receptor antibody (TRAb) acts like a regulatory hormone. TRAb overrides the action of normal regulation of the thyroid leading to the overproduction of the thyroid hormone (Hyperthyroidism).

This is believed to the main cause of the Grave’s ophthalmopathy. This leads to the accumulation of certain carbohydrates in the skin. The same antibody is also believed to influence the dysfunction in the eyes. Grave’s ophthalmology is indicated to occur at the same time as hyperthyroidism.

However, signs of ophthalmopathy may occur several years before or after the occurrence of hyperthyroidism. It can also occur even if there's no hyperthyroidism.

4 Making a Diagnosis

Making a diagnosis of Graves' disease is done by performing several tests.

You will have to see your primary care medical physician. You will also most likely be referred to a specialist of hormone disorders (endocrinologist).

When suffering from Grave’s ophthalmopathy, you will probably be advised to visit an ophthalmologist. However, you will be required to book for an appointment for the visit.

One needs to prepare for the appointment and know what to expect from your doctor. Write down the symptoms even those that are not related. Also, jot down the key personal information such as the

  • medical history,
  • major stresses,
  • recent life change,
  • medication in use currently and previously, including vitamins and supplements and their dosage.

Also, write down questions to ask the doctor on your visit. This may include questions like:

  • What is the most probable cause of my symptoms?
  • What tests do I need?
  • Is there any need for special preparation for the test?
  • Is this condition temporary or permanent?
  • What are the forms of treatment available?
  • Do I have other health conditions associated with this disease?
  • How do I avoid aggravating this condition?
  • Where can I get information about this disease?

And many more other question depending with the time you are allocated for the appointment.

Similarly, prepare to answer questions from the doctor: the questions may include:

  • When did you first experience your first symptoms?
  • Are they continuous or they come and go?
  • Have you been on medication for this condition?
  • Have you lost any weight of late after discovery of this condition?
  • How much weight did you lose?
  • Is there any change in your menstrual cycle?
  • Do you have any sleeping problems?

Diagnosis of the disease includes: physical examination of the eyes for protrusion, enlargement of the thyroid gland since it increases body metabolism.

Change in pulse and blood pressure and signs and tremor. Blood sample can also be used to determine the levels of the thyroid stimulating hormone (TSH), this is the pituitary hormone that stimulates the thyroid gland and change the thyroid hormones.

In Grave’s disease, people have lower than normal levels of TSH and higher levels of the thyroid hormones. Another laboratory test measures the levels of antibody that causes Grave’s disease. The test is not necessary in making a diagnosis, but a negative finding is essential in indicating for hyperthyroidism.

Radioactive iodine uptake can be used to measure the amount of it in the thyroid gland using a specialized scanning camera. This may also determine the rate at which your thyroid gland takes up iodine. The amount of radioactive iodine taken by the thyroid gland which determines if grave’s disease or another condition is the main cause of hyperthyroidism.

This test can also be performed together with the radioactive iodine scan so as to show the visual image of the uptake pattern.

Ultrasound may also be used to produce images of the structures in the inside of the body. It applies the use of high frequency sound waves. It can show whether the thyroid glands are enlarged.

This test is relevant for those that cannot undergo radioactive iodine uptake like in pregnant.

Imaging test can also be used such as CT scan, X- ray technology, and Magnetic resonance imaging (MRI) which uses magnetic fields and radio waves that can be used for making 3-D images. 

5 Treatment

Treatment of Grave’s disease inhibits the production of the thyroid hormones and to block the effect of the hormones on the body.

Some of the treatments may also include, radioactive iodine therapy where radioactive iodine is administered orally. The radio iodine may go into the thyroid cells and as a result of radioactivity, the overactive thyroid cells are destroyed over time. This helps in the shrinking of the size of the thyroid gland reducing the symptoms within several weeks to months.

Radioactive therapy may increase the risk of new or worsened symptoms of grave’s Ophthalmopathy. The side effects are normally mild and temporary. However, this may not be recommended for moderate to severe eye problems. Side effects may include tenderness in the neck and increase in the thyroid hormones.

Radioactive therapy may not be used in the treatment of pregnant or nursing women. This reduces the activity of the decline. Use of anti-thyroid medication may also be used to interfere with thyroid use of iodine so as to produce hormones.

Some of the prescription medications may include: propylthiouracil and methimazole (Tapazole). This drug may require to be taken on long term for better results. Thus drugs can also be used before and after radio iodine therapy as a supplement treatment.

This drugs come with side effects such as:

  • skin rash,
  • joint pain,
  • liver failure
  • or a decrease in disease-fighting white blood cells.

Methimazole is not used in the treatment of pregnant women within the first trimester due to the possibility of birth defects. Hence, propyl uracil is the most preferred anti-thyroid drug in the first trimester.

Beta blockers can also be used to inhibit the production of the thyroid hormones and they do block the effect of the hormones on the body. They also provide relied of irregular heartbeats and tremors, anxiety or irritability, heat intolerance, sweating, diarrhea and muscle weakness.

Beta blockers drugs include:

However, this drugs may not be used for people with asthma, since they may trigger asthmatic attack. They may also complicate the management of diabetes.

Surgery may be used to remove whole or part of the thyroid gland (thyroidectomy or subtotal thyroidectomy). After surgery, one will need treatment to supply the body with normal amounts of thyroid hormones.

Risks of surgery include damage to the vocal cords and other tiny glands located adjacent to the thyroid gland (parathyroid glands). The parathyroid gland produces a hormone that controls the calcium levels in the body. In the treatment of Graves' ophthalmopathy, this can be managed using simple over the counter tears and lubricants.

Corticosteroids can also be prescribed for the condition if the symptoms become more severe. The corticosteroid of choice is prednisone which lowers the swelling behind the eye balls.

However, It comes with side effects such as

  • fluid retention,
  • weight gain,
  • elevated blood sugar,
  • increased blood pressure,
  • mood swings.

Orbital decompression surgery can also be done to remove the bone between your eye sockets (orbit) and sinuses which is the space next to the orbit. This allows your eye to move back to the original position. This is used only when the pressure in the optic nerve threatens the loss of vision. Complications of this surgery is that it can lead to double vision.

Orbital radiotherapy applies the X-rays over the course of several days to destroy some of the tissues that develop behind the eyes. This is only recommended when the eye problems get worse and use of corticosteroids alone is not effective and tolerated. 

6 Lifestyle and Coping

Lifestyle modifications are necessary in order to cope with Graves' disease.

When suffering from Grave’s disease, there is need to ensure that your mental and physical well-being is stable and are a priority.

This is sustained by eating well, exercising and improvement in the symptoms while being treated and feeling better. Management of hyperthyroidism may lead to a tendency to gain weight as a result of the reduction of the thyroid hormone which controls your metabolism. Brittle bones can also come with Graves ’ disease and using weight bearing exercise can sustain the bone density.

Avoid stress at all costs since it can trigger and worsen Grave’s disease. Consult your doctor to incorporate a good nutrition, exercise and relaxation as your daily routine.

For ophthalmopathy, apply cool compresses to your eyes so as to sooth your eyes. Use sun glasses when your eyes protrude to avoid exposure to the UV rays and even more sensitive light. This will also reduce the irritation to the eyes from the wind.

Use of eye drops can also relieve the dry and irritating sensation on the surface of the eyes. Paraffin base gel, lacri lube can be applied when sleeping at night. Always sleep with your head at an elevated position to reduce accumulation of fluids in your head to relieve the pressure in your eye.

Avoid smoking. Use of the counter creams to relieve swelling and reddening. Compression wraps in the legs will manage swellings. 

7 Risk and Complications

There are several risks and complications associated with Graves' disease.

Anybody may develop Graves' disease. They are exposed to risk factors such as:

  • Family history since there is likely a gene or genes that can make a person more susceptible to the disorder.
  • Gender also influences the susceptibility to Grave’s disease. Women are much more likely to develop Graves' disease than are men.
  • Age is also a contributor since only younger than 40 year of age seem to be affected by Grave’s disease.
  • Autoimmune disorders as type 1 diabetes or rheumatoid arthritis, increases the risk of one being exposed to Grave’s disease.
  • Emotional or physical stress can also trigger the onset of Graves’ disease among people who are genetically susceptible.
  • Pregnancy or recent childbirth also poses as a risk to the disease especially among women that are genetically susceptible.
  • Smoking of cigarette affects the immune system, and makes one susceptible to the risk of Graves' disease. Smokers with Graves' disease are also at increased risk of developing Graves' ophthalmopathy.

Complications of Graves' in pregnancy may include

Heart disorders in Graves' disease may lead to heart rhythm disorders, which may cause a change in the structure and function of the heart muscles, and the inability of the heart to pump enough blood to the body (congestive heart failure).

Thyroid storm may also result; it is rare life-threatening complication of Graves' disease. It is characterized by accelerated hyperthyroidism or thyrotoxic crisis. It arises when severe hyperthyroidism is untreated or treated inadequately.

It leads to a sudden and drastic increase in thyroid hormones which may be associated with a number of effects, such as

If you suspect thyroid storm, immediate management and care is required. Untreated hyperthyroidism may cause weak, brittle bones (osteoporosis). The strength of your bones relies on the amount of calcium and other minerals that support the bone formation and regeneration. Excessive thyroid hormone interferes with the body's ability to incorporate calcium into your bones.

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